Being Alive; June, 1998
Marianne Friedman

Fitting, isn't it? After all, nutrition is a science, but most of what is written about it is fiction. My goal in this column is to tell you about that science, and let you make an informed decision about what you want-or don't want-to do. Let's leave fiction out of the equation.

More and more people are turning to nutritional and herbal supplements as an alternative to conventional medicine. It is estimated that 90% of hiv+ people try some form of non-traditional approach to hiv therapy. Seventy percent take at least one unproven supplement from their local healthfood stores. Do you? If so, read on.

Before deciding what is appropriate and what is not, one must differentiate between vitamin supplements (A, B, C, E) and mineral supplements (selenium, iron, zinc, calcium to name a few) and herbal supplements (echinacea, ginseng, ginger and others).

An Integral Part of Therapy

Scientific studies indicate that supplementation with vitamins and minerals can be an integral part of therapy, along with anti-retroviral drugs, and can actually help maintain the immune system, which is placed under exceedingly high demand both by the infection and by the medications themselves. These vitamins and minerals do not act on the enemy (the virus) but they help maintain the defending army (the immune system), keeping it in shape for the continuous battle.

Supplementation with selenium (200­600 micrograms/day), beta-carotene (2­3 x RDA),vitamins C (500 mg­2 g/day) and E (400­800 IU/day) has been shown to have beneficial effects in protecting the immune system against natural damage by our environment (air pollution, sun, and the like). These vitamins are called anti-oxidants because they protect against damage called oxidation (one example of oxidation is rust.) Some recent reports suggest that alpha lipoic acid or ALA (600­1000 mg/day) as well as N-acetyl-cysteine (1­2 g/day) may also play a role in protecting the immune system against oxidation.

Omega-3 fatty acids (in capsules labeled DHA and EPA, also referred to as fish fatty acids), are also increasingly recommended to support immune function, because of their role in preventing the inflammation that accompanies chronic infections.

But besides those well-recognized (and well-studied) vitamins and minerals, several new herbal compounds have appeared on the market as "food supplements." Some of them may be useful while others may actually be harmful.

Not Subject to FDA Regulations

Unlike medications, herbal or nutritional supplements are not subject to FDA regulations. This means that no warning about toxicity is required on the label, and any claim about beneficial effects can be made without supporting evidence. This also means that no quality control exists as to the composition or purity of a supplement. Thus extreme caution has to be exercised when choosing herb-based supplements so that they do not do more harm than good.

Keep in mind that no matter how efficient an herbal remedy may be at possibly maintaining your immune system, it is nowhere near as efficient as medical anti-retroviral therapy at decreasing your viral load. If you choose to use any type of alternative therapy in addition to conventional medicine, make sure you let your physician know about it, since some of these herbs may interact with your medications and place you at risk for serious side effects.

Echinacea

One of the most publicized herbal remedies today is echinacea (Echinacea angustifolia). Acclaimed as the "universal remedy," its uses range from treatment of the common cold to chronic infections. Studies still differ in their conclusions about its efficacy, but supplementation in people with a weakened immune system has so far been contraindicated until more is known about its effects.

However, one preliminary study done in test tubes and on 14 hiv positive people suggests that at doses of up to 1 g three times a day, echinacea may be helpful at controlling the viral load by stimulating natural killer cells (an essential component of your defense system) with little toxicity and at little cost. More research is needed to confirm these findings. What is known is that the prolonged use of echinacea may actually depress the immune system, maybe by overstimulating it.

Therefore it should be taken in on-and-off alternating periods of two to three months, with breaks of three to four weeks to allow for the immune cells to renew themselves.

St John's Wort (Hypericum)

St John's Wort (Hypericum perforatum) has received a lot of attention lately because of its anti-depressive effects, earning it the label of "natural Prozac." It is currently being closely studied for the treatment of certain viral infections, including herpes and hiv. Adverse effects are rare and mild. Recommended doses, based on standardized extracts of 0.3% hypericin (the active component), range from 2 to 3 capsules a day.

Ginseng

Ginseng is another herbal remedy that has been used for centuries in traditional Chinese medicine. Of the three types available on the market (Siberian, American or Korean), only the Korean or Asian type (Panax ginseng) appears to have beneficial effects on the immune system, at doses from 100 to 300 mg of ginseng extract per day.

Several adverse reactions to ginseng have occurred, but they may have been related to other components, since the compositions of the products vary widely, and labeling is not always accurate. People using insulin, anticoagulants or anti-depressants should avoid ginseng because of possible drug interactions.

Garlic

Garlic has been used since the Middle Ages as a protection against infection. It has been shown to have some anti-oxidant activity along with anti-bacterial and possibly immuno-stimulating effects. Other beneficial effects include a lowering of blood cholesterol levels and a decrease in blood pressure. No toxicity but what a breath!!! Unless you choose to use odorless garlic pills, two cloves a day of raw garlic is the recommended dose.

DHEA

DHEA is one of the latest "food supplements" to be closely looked at for its promising effects in stimulating the natural killer cells of the immune system and controlling the viral load in hiv positive people.

Recommended doses for men range from 50 to 200 mg/day in men and from 25 to 50 mg/day in women (overdosing in women may cause the appearance of male characteristics, including hair growth and voice changes.) However, DHEA may be associated with increased risks of breast or prostate cancer and should not be used if you have any risk factors for either (previous occurrence or family history.)

Glutamine and Lecithin

Glutamine, from 1 teaspoon/day to 1 tablespoon/day, helps maintain both the immune system and intestinal function and may be used regularly at the lower dose, with increases to the higher dose during bouts of diarrhea (along with acidophilus and bifidus-enriched products.)

Lecithin granules (not in tablet form which is not absorbed as well) mixed with lemon juice and olive oil have been reported to boost the immune system by increasing natural killer cell activity, without any toxicity. The cocktail is made of 2 teaspoons of lemon juice, 2 tablespoons of olive oil and 2 tablespoons of lecithin granules. (You could add the two cloves of garlic I previously talked about.)

Astragalus and "Cat's Claw"

Astragalus (or Huang ch'i) has been used for centuries in Chinese medicine to stimulate the immune system, and may help fight infections, but caution must be exercised, since overdose may actually cause the opposite effect and suppress the immune system. Too much may actually may be worse than none at all. Beware!

"Cat's Claw" (Uncaria tomentosa or una de gato) is one herb product which, in one study, was found to be extremely powerful at killing in the test tube all cells including natural killer cells (an essential part of your immune system). Thus this compound could actually further weaken the body's natural defenses and may be very dangerous for hiv-infected people.

Bittermelon enemas, Compound Q (sea cucumber extract), and Essiac tea (a mixture of sheepshead sorrel, Indian rhubarb, burdock and slippery elm) have not been shown to have any effect on the viral load or the immune system. Keep in mind that enemas are always dangerous because of the increased risks of damaging or irritating the colon, leading to diarrhea or intestinal infections.

Kombucha Mushrooms

Kombucha mushroom tea (the mushroom is actually a sac formed by the growth of various yeasts and bacteria) may actually be associated with increased risks of fungal infections (because of the fermentation process of the yeast and bacteria with sugar), without any demonstrated positive effect on the immune system. Home-brewed preparations are prone to microbial contamination and may increase risks of parasitic infections.

I hope that I have shed some light on the science behind the fiction. This is meant to help you, but in no way constitutes a recommendation. Let me once again remind you to let your physician know about any supplements or herbal preparations you are taking. Although sold over the counter, herbal remedies are chemicals and therefore could have severe side effects or interactions with medications you are currently taking.

And remember that if you are already taking a lot of pills, priority must be given to your medications over any supplement. Do not forget to take your medications under any circumstance. Forgeting to take your vitamins will not be harmful. Forgeting to take your medications could be.

The Newsletter welcomes our new Nutrition Columnist, Marianne Friedman, a Clinical Dietician at Huntington Memorial Hospital in Pasadena. She works in the outpatient Phil Simon Clinic, counseling hiv+ people. She can be reached by writing to her c/o the hospital's Nutrition Services, 100 W. California Blvd., Pasadena, CA 91109.

Well Enough to Apologize

Two months ago the Newsletter ran an article entitled "Well Enough to Bitch," which quoted various people's experiences with abnormal fat distribution, probably caused by protease inhibitor therapy. Many of the people quoted in the piece had sent their reports directly to us, in response to our earlier request in these pages for news about the abnormalities, often referred to as "protease paunch" and "buffalo hump." While the title of the article was taken directly from the text of one of those people, and was meant to celebrate the fact that many people who were once quite sick are now better, some readers found the title objectionable, and for this we apologize.

(Also, we inadvertently omitted the Internet address of the Crix-List, where we encountered a few of the reports. The Crix-List can be found at crix-list@ pinkpage.com.)

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ÆGIS is made possible through unrestricted grants from Roxane Laboratories, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 1998. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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