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Staying healthy when you're HIV positive is about so much more than taking antiretrovirals. Yes, HIV medications are the most important part of the equation for most people. However, they're not the whole story: For instance, ensuring that your body maintains optimal levels of key nutrients can be critical in maintaining your health.
Much of the time, people with HIV can maintain good nutrient levels simply through a balanced diet, regular exercise and a healthy overall approach to the way they take care of their body. But it's not always easy to do this -- and sometimes, no matter how hard you try, it's still not enough to ensure that you get all the nutrients you need. When this happens, taking supplements can help fill the gaps.
This article will answer a few common questions about vitamins and supplements for people with HIV/AIDS, and provide quick introductions to some of the more popular supplements that HIV-positive people take.
Please note that this article is not meant to be a comprehensive review of everything a person with HIV needs to know about supplements. It's just the beginning of the conversation, and we hope you'll add your own thoughts in the comments section to help that conversation along.
Why Bother With Supplements?
Vitamins and supplements.
The word "nutrients" refers to a group of chemicals that aid in all of the body's natural functions, whether it's cognition, digestion or immunity. Nutrients include vitamins, minerals and amino acids.
You get most of your nutrients by eating food. But if you're living with HIV, food might not always be enough, since the virus can impair your immune system or force it to work in overdrive. This is when supplements can come in handy. Supplements are substances you can take to make up for not getting enough nutrients through your everyday life. Although supplements are usually taken in pill, capsule or tablet form, they can also potentially be in powder or liquid form, and sometimes are required to be injected.
Supplements can control or improve many aspects of your health, including:
- bone health
- brain function
- lipids (such as cholesterol and triglycerides)
- muscle mass
- sleep disorders
Many supplements also have antioxidant qualities, which relieve a condition called "oxidative stress." Oxidative stress occurs in our bodies because every metabolic process produces chemicals that can damage healthy cells. Although oxidative stress happens naturally through illness, aging and other triggers, that stress can perpetuate the activity of HIV within the body. Antioxidants are the shields that protect the body from some of this oxidative stress.
That being said, bear in mind that supplements cannot replace HIV medications. There is no substitute for antiretrovirals when it comes to keeping HIV at bay. There are definitely side effects and other downsides to taking HIV medications, but overall, the long-term side effects of untreated HIV are far more dangerous. And no supplement has yet been found that, conclusively, reliably fights HIV itself -- although there are several supplements that people over the years have claimed can do so.
Does Age Matter?
Whether or not you have HIV, as you grow older, you're more prone to experience certain health problems, such as bone or lipid issues. To that extent, the older you are, the more important it can become to take supplements that help prevent these aging-related health problems.
However, in a broader sense, age isn't an issue when it comes to deciding whether to take supplements. If you eat healthy all the time (a well-balanced meal three times a day, with plenty of fruits and vegetables), don't smoke or drink alcohol, exercise regularly, and if your body is able to absorb food into your bloodstream properly, then it's likely you don't have to take anything beyond your HIV meds.
But not many HIV-positive individuals are able to maintain an ideal diet or lifestyle, and both the physical and emotional effects of HIV can hurt their ability to get all the nutrients they need without a little extra help. That's one reason why researchers are starting to see vitamin deficiencies more and more in HIV-positive individuals at any age.
As anyone who's been keeping up with the latest developments in HIV probably knows, there are a range of health issues that we traditionally associate with aging that appear to be occurring at younger ages in people with HIV. Some of these health issues, such as bone problems (which may be associated with calcium and vitamin D deficiency), can be related to a loss of nutrients. If anything, however, these findings speak to the importance of taking supplements at any age if you need them: Even if some of the health problems that result from vitamin deficiencies occur in people as they get older, the deficiencies themselves may well have been present for a long time -- and filling in those nutrient gaps now may mean fewer problems in the future.
Are There Any Risks to Taking Supplements?
Always be careful about what you put into your body. Even though supplements contain natural nutrients (or products that are derived from natural nutrients), they can still sometimes cause side effects. For instance, although some research has suggested that selenium supplements may help boost the effects of antiretrovirals, selenium is also known to cause a range of potential side effects when taken in too large a quantity -- and experts aren't entirely sure what that "too large" number is.
There are also known interactions between some supplements and certain HIV medications. St. John's wort, for instance, can potentially change the levels of HIV meds in the body, which could reduce the effectiveness of those meds. Interactions such as these make it critical that both you and your health care team know about any supplements you're taking or plan to take if you're on HIV meds.
However, even in cases where there's no known interaction, keep in mind that very little study has been done on potential interactions between supplements and HIV medications. So it's best to separate the time you take supplements and the time you take your meds by five or six hours, just to be safe.
In addition, regardless of the supplement you're considering taking, before you begin to take it, consult with your HIV physician, your nutritionist or a knowledgeable pharmacist, and be sure to research carefully. Keep in mind that with many supplements, it is possible to overdose: Taking too much of a supplement may result in uncomfortable or even potentially dangerous side effects. This makes it even more important to consult with a health care professional before you begin taking one.
What If You Can't Afford Supplements?
Just because you're strapped for cash doesn't mean you have to write off any hope of getting access to important supplements. Here are a few tips to keep in mind:
- Though it's not terribly common, some health insurance plans will cover at least part of the cost of supplements, or may let you take part in special programs that allow you to set aside money from your pre-tax paycheck to buy supplements. Check with your health insurance company to see if that's an option for you. Note that in certain cases (if you're pregnant, for instance), it may be easier to get insurance to cover the costs of a supplement.
- If you're eligible to take part in an AIDS Drug Assistance Program (ADAP), keep in mind that some state ADAPs cover supplements, although you may need a prescription for them and may need to buy them from specific ADAP-approved pharmacies.
- There are almost always cheaper alternatives to buying supplements from a nearby vitamin shop or supermarket. For instance, organizations known as buyers' clubs, which include the New York Buyers' Club and the Houston Buyers Club, specifically exist to help people with HIV/AIDS and other conditions group together to get the supplements they need as inexpensively as possible.
- As mentioned, few studies have been done on supplements in HIV-positive people. But there are studies out there -- and participating in one may be a handy way to get access to free supplements, at least while the study is ongoing. Talk to your doctor, nutritionist and local HIV/AIDS service organization about any studies they may know of, or conduct your own search: For example, ClinicalTrials.gov, an official U.S. government site, has a searchable listing of open studies involving supplements and HIV.
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.
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.)
- 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.
- 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.
- What It Does: B vitamins (including B12) regulate the body's metabolic processes, which include producing energy, regulating the heart and maintaining healthy nerve cells.
- What B12 Deficiency Can Cause: diarrhea, fatigue, lack of concentration, neurological damage (in extreme cases), peripheral neuropathy, some types of anemia
- People at Higher Risk for B12 Deficiency: people over 50, vegetarians, people with gastrointestinal problems
- Types of B12 Supplements: B12 is often found as part of a "B complex" vitamin that includes other B vitamins. It's available as a dietary supplement in pill form or as a lozenge. It's also available by prescription as a nasal spray or an injection.
- How Much Is Needed: U.S. RDA is 2.4 mcg (micrograms) for people over the age of 13 (more if you're pregnant or lactating).
- Foods in Which It's Most Commonly Found: meats (especially beef and other red meats), fish, clams, milk, cheese, eggs
- For More Information: Visit our vitamin B index page.
- What It Does: Zinc helps to produce testosterone and preserves sexual function, both of which can often be a concern for men living with HIV.
- What Zinc Deficiency Can Cause: diarrhea, immune system damage
- People at Higher Risk for Zinc Deficiency: heavy alcohol drinkers, people with gastrointestinal or digestive problems, pregnant/lactating women, vegetarians
- Types of Zinc Supplements: Zinc supplements are generally taken in pill form, although a number of over-the-counter medications (especially cold remedies) contain zinc, as do some throat lozenges, nasal sprays and gels -- caveat: there have been some reports of people losing their sense of smell by taking zinc supplements through their nose. Also, note that the more zinc you take, the lower your body's levels of copper (which is necessary for proper immune function) tend to become. That is why zinc supplements often contain copper as well.
- How Much Is Needed: U.S. RDA is 11 mg for men over the age of 18 and 8 mg for women over the age of 18 (more if you're pregnant or lactating).
- Foods in Which It's Most Commonly Found: shellfish, meats, dairy products, some beans, nuts
- For More Information: Visit our vitamin index page.
Multivitamins: The All-in-One Solution
A daily, complete multivitamin pill can serve as a good source for many of the nutrients listed above, as well as a number of others. There are also indications that multivitamins help delay the progression of HIV disease, as found in a long-term, randomized trial that was conducted in Tanzania, Africa.
However, figuring out which multivitamin to use can be a dizzying experience. There are a large number of different multivitamin pills sold by different companies, all of which contain different dosages of a wide range of nutrients. You may be best off speaking with your doctor or nutritionist to first learn more about what nutrient deficiencies you may have; then you can compare multivitamins to see which is likely to fill your needs best. Visit our "multivitamins and HIV" index page to learn more.
Additional reporting for this article was provided by Myles Helfand.