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An Introduction to Dietary Supplements for People Living With HIV/AIDS

June 24, 2010

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What Nutrients Should You Take Supplements For?

It's tough to determine which supplements, if any, are "the best" for HIV-positive people to take. One major reason is that individuals can have different deficiencies in certain vitamins, minerals and other nutrients.

The ideal scenario is to have your doctor run blood tests to measure your levels of each of the nutrients listed below. If any deficiencies are found, talk with your doctor or nutritionist about what they mean and whether supplementing is the best way to get your levels back up into a healthy range.

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Another reason it's hard to identify "the best" dietary supplements to take is that there's limited research and no guidelines when it comes to supplementation among people with HIV. The recommended daily allowance (RDA) of dietary nutrients in the U.S. was established many years ago -- and it was based on a population of HIV-negative men in relatively good health. If anything, as an HIV-positive person, you arguably need more than the RDA of some nutrients, since your immune system tends to be under more stress.

One of the most frequently asked questions that people living with HIV have is, "Will a supplement on top of my HIV meds give me an improved immune recovery or immune function?" The bottom line is that health care professionals don't know for sure. But what is known is that some supplements are a very good idea for your health overall.

To find out about some of the specific supplements that should be on your shopping list, we spoke with HIV and nutrition expert (and longtime HIV survivor) Nelson Vergel. He regularly answers questions in our "Ask the Experts" forum on nutrition and exercise, and he recently conducted a survey on complementary therapy use by HIV-positive people that included a breakdown of the most popular supplements and the reasons people took them. With his help, we've put together an alphabetical list of some of the nutrients that are especially worth watching -- and the supplements that may be most worth taking -- if you're a person living with HIV. As we mentioned earlier, this isn't meant to be a comprehensive list of all the nutrients and supplements you should know about if you're HIV positive. Think of it as the beginning of a conversation that you should continue with your doctor or nutritionist, as well as additional research on TheBody.com and elsewhere. Please offer your own thoughts and experiences in the comments section at the bottom of this article!

(One quick note on forms of supplements: Most supplements are available not only as pills (i.e., tablets or capsules that you swallow), but also in liquid or gel formulations that can be injected or applied via nasal spray. Injections and nasal sprays tend to be much more potent than pills, so they might be used in cases of a severe nutrient deficiency. Generally speaking, supplements in pill form are readily available without a prescription, but injections and nasal sprays require prescriptions or must be administered under the supervision of a health care professional.)

Alpha-Lipoic Acid

  • What It Does: Alpha-lipoic acid is a strong antioxidant that improves the way insulin captures glucose for later use. As such, it's being researched for its potential to improve insulin sensitivity in people who have diabetes. There has also been some indication that it may help treat peripheral neuropathy (particularly when taken as an injection) and could have some neurological benefits as well.
  • What Alpha-Lipoic Acid Deficiency Can Cause: Little is known about the risks of not getting enough alpha-lipoic acid. What we know about alpha-lipoic acid tends to be more related to what we believe is good about having it rather than what's bad about not having it. Alpha-lipoic acid's antioxidant powers center around its ability to increase the body's production of a liver-cleansing chemical called glutathione. We have seen data showing that people with HIV have low levels of glutathione compared to HIV-negative people, which suggests alpha-lipoic acid can help, but we don't know much about what might happen to HIV-positive people as a direct result of lower glutathione levels.
  • People at Higher Risk for Alpha-Lipoic Acid Deficiency: Experts aren't yet sure.
  • Types of Alpha-Lipoic Acid Supplements: In addition to pill form, alpha-lipoic acid is available as an injection, though it needs to be given under the supervision of a health care provider.
  • How Much Is Needed: There is no U.S. RDA.
  • Foods in Which It's Most Commonly Found: green, leafy vegetables; red meat; organ meats
  • For More Information: Visit our vitamin index page.

Calcium and Vitamin D

  • What They Do: These may be the two most prominent nutrients being researched in HIV today. Bone disease seems to be a problematic trend among people with HIV, even at relatively younger ages than those normally associated with the start of bone problems. Calcium is important for proper heart, muscle and nerve function. It also plays a major role in preventing osteoporosis, by growing and maintaining healthy bones. Vitamin D is good for immune function and boosts the body's ability to absorb calcium.
  • What Calcium or Vitamin D Deficiency Can Cause: Bone disorders. Researchers are also exploring whether there is a link between low calcium/vitamin D levels and some cancers.
  • People at Higher Risk for Calcium or Vitamin D Deficiency: lactose-intolerant people, obese people, older people, people with dark skin, people with kidney problems, people with metabolic disorders, postmenopausal women, vegetarians
  • Types of Calcium or Vitamin D Supplements: Although we get some vitamin D from our food and can naturally form it by absorbing sunlight through the skin, it may not be enough for people living with HIV. Some of the foods we buy are artificially fortified with vitamin D (milk, for instance), but you can also buy vitamin D2 and D3 supplements, both of which can increase your vitamin D levels (although D3 is believed to do so more effectively). Calcium supplements exist in a variety of forms, including pills and tablets that you can chew or dissolve in a drink (such as Rolaids and Tums).
  • How Much Is Needed: U.S. RDA for calcium varies a bit by age; adults between the ages of 19 and 50 have an RDA of 1,000 mg, with the RDA increasing to 1,200 for people over 50. Vitamin D is measured in IU (international units), with an RDA of 200 IU for people between 19 and 50, doubling to 400 IU for people 51 to 70, and tripling to 600 IU for people over 70.
  • Foods in Which It's Most Commonly Found: Calcium is commonly found in dairy products and green, leafy vegetables. Vitamin D is most often found in fatty fish (such as salmon and tuna), and milk is often artificially fortified with vitamin D. Our skin also makes vitamin D naturally when it's exposed to sunlight.
  • For More Information: Visit our vitamin D index page.

Carnitine

  • What It Does: Carnitine (also called acetyl-L-carnitine or L-carnitine) shuttles fat droplets into the mitochondria, which are the energy factories within your cells. Mitochondria use sugar and fats to produce energy; carnitine improves the ability to use that fat for energy. Research suggests that carnitine decreases cholesterol and triglycerides in people with diabetes, and people generally report better mood and energy levels after beginning to take it. (Vergel is a true believer himself: He's taken carnitine regularly for over 20 years. Sometimes he runs out of it -- and that, he says, is when he realizes how well it improves his energy and ability to focus.)
  • What Carnitine Deficiency Can Cause: a range of problems related to heart, muscle and liver function, including fatigue and male sexual dysfunction
  • People at Higher Risk for Carnitine Deficiency: older people, people with HIV, people on cancer treatment, people with severe liver problems
  • Types of Carnitine Supplements: Carnitine supplements are available as pills, powders (which can be mixed into drinks), liquid solutions and even wafers without a prescription. (It may appear on the bottle's label as acetyl-L-carnitine, L-carnitine or propionyl-L-carnitine.) It's also available by prescription, and can be administered intravenously by a health care professional.
  • How Much Is Needed: There is no U.S. RDA, and experts recommend a different dose of carnitine depending on the reason a person is taking it (e.g., for fatigue, erectile dysfunction, heart disease, etc.). Experts tend to recommend a dose somewhere between 1 g and 3 g (grams) per day, but talk to your doctor or nutritionist to determine what's right for you.
  • Foods in Which It's Most Commonly Found: red meat, fish, poultry, milk
  • For More Information: Visit our vitamin index page.

Coenzyme Q10 (CoQ10)

  • What It Does: Found in the mitochondria, CoQ10 is involved in the production of adenosine triphosphate (ATP), which is the major source of energy for cells and drives many biological processes. It also acts as an antioxidant, and animal studies have suggested it may be an immune booster.
  • What CoQ10 Deficiency Can Cause: It's not clear. Research to date has taught us more about how increasing CoQ10 levels might help people (namely by increasing energy levels and boosting the immune system) rather than how low CoQ10 levels might hurt people.
  • People at Higher Risk for CoQ10 Deficiency: older people, people who use statins to lower their cholesterol, people with HIV and other chronic conditions (e.g., heart conditions, muscular dystrophies, Parkinson's disease, cancer and diabetes)
  • Types of CoQ10 Supplements: CoQ10 supplements are available in a range of different forms taken by mouth, including capsules, tablets, sprays and pills that dissolve under the tongue.
  • How Much Is Needed: There is no U.S. RDA.
  • Foods in Which It's Most Commonly Found: meats, poultry, fish, soybean and canola oil, some nuts and seeds
  • For More Information: Visit our vitamin index page.
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This article was provided by TheBody.com.
 
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Reader Comments:

Comment by: Judy (Egypt) Thu., Mar. 1, 2012 at 8:24 pm EST
What about astragalus? I read a book by Dr. Andrew Weil and he recommended this for people with chronic immune conditions like HIV. This and maitake mushrooms,calcium,garlic and some others this article addresses.
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Comment by: MsCharlie (south africa) Thu., Jul. 28, 2011 at 8:06 am EDT
Over the weekend I found out I was positive, Im 27yrs old, my CD4 is 1004. Wat supplements can you suggest. I havent told anyone except my boyfriend, dont think Im going to tell anyone. Im all alone please advise.
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Replies to this comment:
Comment by: basilia (png) Sat., Sep. 7, 2013 at 1:43 am EDT
how did you became positive please can you explain


Comment by: Social Worker (India) Fri., Jun. 3, 2011 at 4:29 pm EDT

1) Good diet
2) Exercise
3) Enough sleep
4) Stay away from drugs
5) No to unprotected sex

Increase your CD4...
Reply to this comment
Replies to this comment:
Comment by: Mosley (Dietitian) (south africa) Tue., Aug. 16, 2011 at 8:00 am EDT
you are very right social worker


Comment by: Anonymous (Detroit, Mi) Tue., Jan. 4, 2011 at 2:54 pm EST
I drink green tea every day,take a multi vitamin with 200mg selenium and do yoga. This regimin took my cd4 from 400's to 600.
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Comment by: Jay (houston Tx) Sun., Jan. 2, 2011 at 5:58 pm EST
coconut oil is very good 2 tbls a day
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Comment by: Christos (athens) Tue., Dec. 28, 2010 at 10:51 am EST
hi from athens Greece.... for 2 years I had undetectable virus load but my immune system had stabilized around 230 cd4. Before one month my doctor told me that my immune system dropped at 180 cd4...
I had to do something so I started to take daily (zinc,drinking a lot of fresh orange juice, selenium,Omega3 ,A,D,Q10,L-carnitine,tetosterone) and I went back after 3 weeks to count my cd4....it went up at 350 from 180 ....I was at 230cd4 for more than 3 years with undetectable virus load....I m taking norvir/intelence/presista /truvada ...I dont which of all helped me to increase immunes cells but I will keep going with this combination...Good luck to all of us...but supplements are helping a lot...
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Comment by: EUCABETH (Kenya) Tue., Sep. 21, 2010 at 2:17 am EDT
As far as i know supplments should be recommended to hiv patient in situations that patient has recorded a high instance of a particular nutrient diffiency thats attributed by the related factors or generally inadequacy of the intake of that nitrient in terms of dietary intake,maybe to correct the diffiency.
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Comment by: Stephanie (East London) Fri., Sep. 3, 2010 at 9:19 am EDT
All types of supplements and pills of all sorts are invented to help maintain the patients health and also to help them with the prevention of lacking certain nutrients. I am a nutritionist and in my profession, if you have the money to buy supplements as such then the patient should buy it indeed. But in a poverty stricken situation, clearly we discourage the unnecessary spending on these pills which will then promote and provide sufficient disposable capital to the patient to spend on nutritious foods instead of pills. There is advantages and disadvantages to using supplements with any sickness, however ignorant people shouldn't slander against such supplements.
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Replies to this comment:
Comment by: Mosley (dietitian) (limpopo) Tue., Aug. 16, 2011 at 8:03 am EDT
it is not very necesary to take supplements if you can take adequate diet orally even if you have money you dont have to but them


Comment by: ralph (tn) Sun., Aug. 29, 2010 at 9:52 am EDT
Your Dr. Should Question you well on your Overall Well-Being and have Him/Her Suggest the Right Sups for You,Ig not "ASK" .But I Know these Sups won't work for Everyone,we're all different taking different meds on different Hiv Levels. I'm a 2 year old Vet of HIV and I'm still learning the ropes. Think/Consult your Dr. Before you Act on these Sups.You may save yourself some or Alot of unnessary Grief.Thank You
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Comment by: (Des Moines, WA) Mon., Aug. 23, 2010 at 11:56 pm EDT
you people shut up because if this information does not benefit you then leave it behind nobody is forcing you to do it! what doesnt people you may help somebody else.
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Comment by: marie (michigan) Thu., Aug. 12, 2010 at 3:47 pm EDT
supplements do not help but make bacteria grow.
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Comment by: Mathew (Niger) Mon., Aug. 2, 2010 at 5:40 pm EDT
We should always back our atricle with real proof and not by mere writing. People wit hiv should not be led to spend their money unecessary. God is watching. The sickness may be any of us. Thank u
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Comment by: s.l (jamaica) Tue., Jul. 13, 2010 at 4:30 pm EDT
dietery supplements are not relevant the important thing is to keep a good diet ..stay away from sugar fructose corn syrup [hfcs]..eat fresh fruits and vegetables an use oilve oil to cook ..eat natural no sodas or things like that
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Comment by: Myles Helfand (TheBody.com) Fri., Jul. 9, 2010 at 1:14 pm EDT
@George: Actually, there's a whole section on calcium and vitamin D on page 3 of this article. :) It's also worth noting that the most compelling info we have on bone density issues for HIV-positive women is among *postmenopausal* women, where studies have shown a higher risk of not just low BMD, but actual bone fractures.

All that said, though, I just want to take a moment to remind y'all of a point made a couple of times within the article itself: This is by no means meant to be a comprehensive list of supplements to take, or of specific vitamin deficiencies you need to watch out for, if you're living with HIV. We've got lots of other articles on our site that provide additional information; this one is meant to help get you started on some of the important issues. Your comments help add a lot to the discussion! (Well, those that aren't from trolls trying to sell their products. :) )
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Comment by: George (Palm springs) Thu., Jul. 8, 2010 at 1:44 pm EDT
This is really superficially done. There have been loads of findings about vitamin d3 deficiency in people with HIV. Why isn't that here? Plus loads of stuff about calcium because of bone density issues in people with HIV (particularly in women). This little guide is not for HIV positive people.
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Comment by: James (Atlanta) Tue., Jul. 6, 2010 at 4:16 pm EDT
Supplements are great! I became resistant to Atripla a couple of years back and after doing research discovered the benefits of selenium and alpha lipoic acid. I took these two supplments faithfully. I recently went back to my doc. I have no mutations and I currently take Atripla again.
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Replies to this comment:
Comment by: Joe (Florida) Tue., May. 10, 2011 at 11:07 pm EDT
James, what benefits have you gotten from these supplements as far as your CD4 count and anything else that you think would be beneficial for a guy?


Comment by: Drew (Sydney , AUS) Mon., Jul. 5, 2010 at 7:07 am EDT
This is all about MONEY... There is no Science to back up Vitamins/Supplements

I urge everyone to think twice in regards to using these pills.

Capitalism never cares about the HIV Communities health only profit margins $$$$$$

Be warned !!!
Reply to this comment


Comment by: Debbie (Florida) Mon., Jul. 5, 2010 at 1:51 am EDT
My Best friend is HIV positive and I have tried finding so many products to help him find some relief. I was told about a product from a lady named Candace halls that has changed his life, he feels a lot more energized and a lot stronger. So if you are willing to try something that might help you go to. Ardysslife.com/candacehalls
and look for LeVive or you can get a power pack email candace at candace_charity@hotmail.com
I hope this will help someone the way it's helped my best friend.
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Comment by: Leslie (Manitoba, Canada) Sun., Jul. 4, 2010 at 10:01 am EDT
With all these drugs that are used to deal with HIV, I think Milk Thistle would be an invaluable addition. I read from several sources that it aids the Liver and since this organ processes everything that goes through the body. it should be included.
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Comment by: L. C. (Chicago, IL) Fri., Jul. 2, 2010 at 10:56 am EDT
I attended a complementary and alternative medicine (CAM) and HIV presentation a few years ago. The presenter (an MD)mentioned that astragalus (a Chinese herb) has been shown to stimulate the immune system, protect it from chemotherapy/RT, increase CD4 count. It has also been used to treat hep C. He said the recommended dose is 1,000-1,500 mg daily.
Has anyone out there heard more on the subject?
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Comment by: Rick (North Carolina) Fri., Jul. 2, 2010 at 6:00 am EDT
D.J. Thanks for the very useful supplement information.
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Comment by: Gary (Wichita) Thu., Jul. 1, 2010 at 11:47 pm EDT
EGCG, the main component of green tea, has been shown to be very effective in increasing the immune response, thereby lowering the viral load and increasing CD+4. EGCG also seems to lessen many of the side effect of taking antiretrovirals. Drink lots of green tea or take lots of powerful green tea extracts. Cell Pro 7 is a good one. Go to www.pubmed.gov and search for HIV EGCG and see all of the research.
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Comment by: Mark (London) Thu., Jul. 1, 2010 at 4:51 pm EDT
I wouldn't touch most of those supplements with a 10ft bargepole, even if you paid me, unless I had a diagnosed medical need to be taking them and had discussed that need with a dietician.

Like Karen, I take a daily cheap pharmaceutical grade multivitamin and mineral tablet; but beyond that, this long-term survivor gets by just fine on a sensible and uncomplicated varied diet.

If you are going to supplement, don't go for unsupervised megadosing or any of the ludicrously expensive patent formulations that are so unscrupulously marketed to part the HIV-positive with their money - all you will get if expensive urine and the possibility of a needless toxic overdose or an unexpected adverse interaction.

Keep it simple, keep it sensible, get professional advice and be honest with your doctor about what, and how much, you are taking.
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Comment by: Karen Geronymo RDLD/N (Miami Beach, Florida) Tue., Jun. 29, 2010 at 3:19 pm EDT
Though I don't generally recommend a large variety of vitamin and mineral supplements for the average stable person living with HIV as many supplements are frequently not well studied for benefits/disavdvantages/interactions with medications, their content and production location is often unregulated by the FDA, and they can be costly for those on a limited budget. I do, however recommend a Pharmaceutical grade or USP (United States Pharmacopia) designated multivitamin and antioxident supplement IN ADDITION TO a healthy and varied diet. Whenever possible, a person with HIV should meet with a Registered Dietitian at least one time to help assess their needs and provided education as necessary.
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Comment by: D.J. (Wilton Manors, FL) Sat., May. 22, 2010 at 1:46 pm EDT
I think we missed some important supplements in this article. Niacin (Extended Release)- to reduce Cholesterol and Triglycerides, Potassium - purely for the vasodilation properties and taken 2 - 1 to Calcium as Calcium is a vasoconstrictor, CLA - to help move and balance fat deposits (buffalo hump and visceral fat), Fish Oil - to help with Cholesterol and Triglycerides as well, Selenium and Vitamin A as Beta Carotene - in combination stave off Thrush and actually reversed the Leukoplakia I had developed. Since taking Selenium and Beta Carotene I have not has a single sore throat or incident of Thrush...things that plagued for for over 2 years.

I think Evening Primrose Oil is also a recommendation as it has helped me with Insulin Resistance. I have stopped taking EPR 3 times and all three times my doctor has mentioned that my blood sugar has risen. She now recommends all of her patients take Evening Primrose Oil.
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