Vitamins: Alternative Treatment or Necessary Therapy?

Vitamins and minerals are necessary for everybody. They play an even bigger role in the nutritional status and health of individuals with HIV/AIDS. Vitamin/mineral supplements often become an important component of treatment, whether self-prescribed or recommended by your physician or dietitian. Figuring out whether to take supplements and in which amounts, can be as important a decision as which medications to take.

The Basics

Vitamins are essential, organic nutrients needed in tiny amounts by the body in order to survive. Vitamins do not provide calories (energy), but they do help the body to digest and use other energy-containing nutrients: fats, carbohydrates and proteins. Although we don't need very many vitamins, nor do we need large amounts, the vitamins accomplish mighty tasks, many of which are still being discovered, especially in HIV disease.

Certain vitamins are in foods in forms known as precursors. For instance, beta carotene is a precursor to vitamin A, which means it is changed inside the body to vitamin A.

Fat Soluble

Fat soluble vitamins include vitamins A, D, E and K which are stored by the body to meet any future requirements. This means there is an increased risk of harmful side effects due to buildups. In particular, vitamin A has been shown to be harmful (toxic) when consumed in large amounts.

Water-Soluble

On the other hand, water-soluble vitamins, such as B-vitamins and vitamin C, are absorbed and the excess is carried out of the body in urine. Unlike fat-soluble vitamins which are stored, water-soluble vitamins need to be consumed every day in small amounts.

Many people mistakenly believe that water-soluble vitamins are not harmful in large amounts since you excrete what you don't need. Although relatively rare, toxicity from water-soluble vitamins can occur. For example, vitamin C (in amounts greater than about 1000 mg.) can cause nausea, stomach cramps and diarrhea. Long term use of vitamin C at levels greater than 1500 mg./day may result in copper deficiency.

Minerals

Minerals are natural elements that are needed by the body to perform various functions and keep the immune system healthy. Several minerals, including zinc, selenium and iron are receiving a lot of attention as having various roles in fighting HIV. Researchers are finding low levels of selenium in people with HIV/AIDS. Selenium works with vitamin E and appears to improve immune function and possibly slows progression of HIV. The recommended daily intake (RDA) for women is 55 mcg. with toxic effects at 1000 mcg.

Iron

Iron is another mineral commonly prescribed for those with HIV. The role of iron in the function of the immune system is debated. Evidence suggests that both an excess of iron or a deficiency (not enough) can increase the risk of infectious diseases. Iron deficiency negatively affects the immune system yet, deficiency may also serve to prevent infections because invading organisms (germs) require iron to thrive.

Anemia is common among women. If you suspect you are anemic, find out the cause. Iron deficiency isn't the only cause of anemia. Infections and inflammation, kidney disease, side effects of drug therapy (AZT), misuse of nutrients, lack of iron, vitamin B12, folate, copper, vitamin C and protein can all cause various types of anemia. Be sure to consult with your physician.

Antioxidants

Antioxidants are also getting a lot of press lately for their beneficial role in preventing and fighting HIV disease. Antioxidants disarm what are called "free radicals" or body cells that have gone haywire. The body produces free radicals in response to infections, pollution, smoke, and even sunlight. Free radicals stress the immune system by damaging DNA, killing cells and changing various chemicals in the body. By neutralizing the free radicals, the body successfully prevents damage to cells. Growing evidence indicates that antioxidants may also slow progression of HIV. (On the other hand, too many antioxidants can cause harm.)

Deficiencies of folate and possibly the antioxidants, vitamin C, E and beta-carotene may also be linked to an increased risk of cervical dysplasia in women.

Special Needs

Growing research is reporting low serum levels and/or deficiencies of several nutrients among people with HIV. These include many of the B vitamins(riboflavin, folate, B6 and B12), and the minerals zinc and selenium. Unfortunately, data specific to HIV+ women is sorely lacking. However, it is safe to say that when it comes to getting enough vitamins, minerals and other nutrients, women with HIV face a big challenge.

A woman's body makes her more likely, compared to a man, to suffer from nutrient deficiencies during various transitions of her life such as puberty, pregnancy and menopause. Half of all women in the U.S. already eat less than two-thirds of the Recommended Dietary Allowance (RDA) for folic acid, iron, zinc, calcium, magnesium, copper, vitamins A, D, E and certain B vitamins. (Please note the RDA levels are set for "healthy" Americans and do not consider HIV status which we know often increases these needs.)

Women also go on weight loss diets, repeatedly and often. The average daily caloric intake for women in the U.S. is 1400 to 1800 calories, compared to more than 2500 calories for men. It is nearly impossible to meet even basic RDA levels of vitamins/minerals, let alone the increased needs for HIV when intake is restricted to such low levels.

Supplements

Vitamin and/or mineral supplements should not be used to replace food. Intake through better eating is preferable. That's because vitamins and minerals work together with other nutrients found in protein, carbohydrates, fat and water.

A good reason to try to get as much nutrients as possible from food is that there may be other components in food that are not in supplements. For instance, food sources of beta-carotene are great sources of other powerful antioxidants not contained in beta-carotene supplements. Nutrients in foods are more powerful and will produce fewer side effects, compared to the pill or capsule form of the same nutrient. Side effects from supplements may include harm to the immune system and toxicity in the blood.

Vitamin/mineral supplementation should be reevaluated from time to time. Vitamin deficiencies can change over time. Your bodies ability to absorb nutrients may improve or lessen.

Food Sources of Antioxidants

Beta-Carotene (Vitamin A)

Pumpkin, sweet potato, mustard greens, carrots, winter squash, kale, apricots, carrot juice, spinach, cantaloupe, broccoli, and mango.

Vitamin C

Citrus Fruits, red/green peppers, cantaloupe, cabbage, strawberries, brussels sprouts, mango, potato, kiwi fruit, broccoli, cauliflower, and fortified cereals.

Vitamin E

Wheat germ oil, safflower oil, mayonnaise, wheat germ, cottonseed oil, fortified cereals and breads, almonds, avocado, and whole grains.

Selenium

Brazil nuts, seafood, eggs, organ meats, chicken, cereals & breads, lean meats, beans, and whole grains.

Designing A Program

1. If you have access to a registered dietitian or nutritionist who is familiar with the needs of women with HIV, he/she and your physician can help determine effective but safe levels of vitamins tailored to your individual needs. Your dietitian can analyze your actual intake of nutrients and recommend specific foods or supplements to boost any shortfalls in your diet.
   
2. In lieu of a personal assessment with a dietitian, select a "balanced" multivitamin/mineral tablet rather than several individual supplements. Centrum or Theragran-M or the store brand equivalent are good choices. Your body will never know the difference if you spend more or less money.
   
   Avoid taking more than 200% of the RDA unless you have consulted with your physician or dietitian. While there is some evidence that indicates that 20 to even 200 times the RDA of certain nutrients may be beneficial, conclusive research remains to be done, particularly for women.
   
3. Avoid selecting supplements based on enticing phrases like "immune boosting". Read the back of the label to see what's really in the bottle. Remember that someone selling supplements may not be objective about advising you on which supplements to take. After all, they're trying to make money.
   
4. Consider taking an antioxidant regiment of vitamins C, E, beta-carotene and selenium. Although there is a wide range of recommendations on how much to take, you will want to stay below the following toxic levels:
   
   
   • Vitamin C: 1,500 - 5,000 mg. (at 1,000 mg., you may experience diarrhea, nausea and stomach cramp) Gradually increasing doses helps some people to avoid these side effects.
     
     
   • Vitamin E: 1200 IU
     
     
   • Beta-carotene: 25,000 - 50,000 IU
     
     
   • Selenium: 100 mcg
   
   
   
5. Take supplements with a full glass of water or other liquid to help it dissolve. Supplements are absorbed better if there is some food (digestive enzymes) in the stomach.

One Final Caution

If you are experiencing a lot of diarrhea, you may want to back off of any large amounts of nutrients like vitamin C or beta-carotene.

Consider your liver function. There is some evidence that even large doses of beta-carotene which is thought to be fairly nontoxic, can have a negative impact because it is processed by the liver. Fat-soluble vitamins are stored by the liver and may present greater complications for someone with liver disorders. One estimate is that approximately 60% of people with HIV have some form of liver disorder.

Supplements in any amount are an individual choice that hopefully is made with input from a dietitian and physician. It is important to start with a well-balanced, healthy diet and add supplements as needed. The potential harm from supplements is just as important as the health benefits. If you have concerns about any of your treatments, check with your physician.

Lisa A. Ploss, RD, MPH is a nutritionist in the San Francisco Bay Area who focuses on HIV and women's health issues. She can be reached at (510) 337-0479