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Medical Forum / General / Nutrition / June 2005HIV and vitamins (specifically vitamin C)
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=15215767&query_hl=2 US youths in the early stages of HIV disease have low intakes of some micronutrients important for optimal immune function. Kruzich LA, Marquis GS, Carriquiry AL, Wilson CM, Stephensen CB. Department of Food Science and Human Nutrition, Iowa State University, Ames, USA. lkruzich@iastate.edu OBJECTIVE: We examined the association between micronutrient intakes and human immunodeficiency virus (HIV) infection in youths who were at increased nutritional risk because of the demands of growth and disease as well as poor dietary habits. DESIGN: This was a cross-sectional study to collect dietary intake data using the Block Food Frequency Questionnaire (98.2). Anthropometric, biochemical, clinical, and sociodemographic data were available.Subjects/Setting Participants included 264 HIV-infected and 127 HIV-uninfected adolescents and young adults from the Reaching for Excellence in Adolescent Care and Health network, a multisite observational study on HIV progression.Statistical analyses CD4(+) T cells were stratified for HIV-infected youths: >/=500, 200 to 499, and <200 cells/microL. Micronutrient intakes were compared by presence of HIV infection, using two-sample Student's t tests. Categoric analyses used chi(2) test. Generalized linear regression determined predictors of vitamins A, C, and E; iron; and zinc intakes. RESULTS: Almost half (49.0%) of the HIV-infected participants had CD4(+) T cells >/=500 cells/microL. After controlling for other factors, HIV-infected participants with CD4(+) T cells >/=500 had decreased iron intake (P<.05) and tended to be associated with lower intakes of vitamins C and E (P<.10) compared with those with more advanced disease and HIV-uninfected youths. Among those youths with CD4(+) T cells between 200 and 499 cells/microL, a high anxiety score was associated with a sixfold increase in vitamin A intake as compared with those with a low score.Applications/conclusions Given the increased micronutrient requirements, nutrition counseling with HIV-infected youths should focus on early increase of intake of foods rich in micronutrients to improve growth, slow disease progression, and increase survival. ---- Nutrition is a major factor in HIV and other viral infections. TC > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=15215767&query_hl=2 > [quoted text clipped - 24 lines] > > TC also: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=11864781&query_hl=2 Supplementation with antioxidant vitamins prevents oxidative modification of DNA in lymphocytes of HIV-infected patients. Jaruga P, Jaruga B, Gackowski D, Olczak A, Halota W, Pawlowska M, Olinski R. Department of Clinical Biochemistry, The Ludwik Rydygier Medical University, Bydgoszcz, Poland. There is evidence suggesting that patients infected with human immunodeficiency virus (HIV) are under chronic oxidative stress. In the present study, the level of oxidatively modified bases in lymphocyte DNA and some other parameters of oxidative stress were measured in HIV-infected patients (n = 30), as well as in control groups (10 healthy volunteers and 15 HIV-seronegative injected drug users). Additional experiments were conducted using lymphocyte DNA samples from asymptomatic seropositive, HIV-infected patients who were supplemented with antioxidant vitamins A, C, and E or received placebo. Significant increases in the amount of the modified DNA bases were observed in HIV-infected patients when compared with the control group. The concentration of thiobarbituric acid reactive substances (TBARS) was higher and activities of antioxidant enzymes (superoxide dismutase and catalase) were lower in the group of HIV-infected patients in comparison to the control group. Vitamin supplementation resulted in the significant decrease in the levels of all modified DNA bases when compared to the patients who received placebo. The reduction of TBARS and the restoration of the activity of the enzymes were also observed. Our data suggest that people infected with HIV can benefit from treatment with antioxidant vitamins. -------- TC > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=15215767&query_hl=2 > [quoted text clipped - 24 lines] > > TC also: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=15501479&query_hl=8 AZT induces oxidative damage to cardiac mitochondria: protective effect of vitamins C and E. de la Asuncion JG, Del Olmo ML, Gomez-Cambronero LG, Sastre J, Pallardo FV, Vina J. Departament of Anesthesiology and Critical Care, University Clinical Hospital, Valencia, Spain. AZT (zidovudine) is a potent inhibitor of HIV replication and a major antiretroviral drug used for AIDS treatment. A major limitation in the use of AZT is the occurrence of severe side effects. The aim of this work was to test whether AZT causes oxidative damage to heart mitochondria and whether this can be prevented by supranutritional doses of antioxidant vitamins. An experimental animal model was used in which mice were treated with AZT for 35 days (10 mg/kg/day) in drinking water. Animals treated with antioxidant vitamins were fed the same diet as controls but supplemented with vitamins C (ascorbic acid, 10 g/ kg diet) and E (alpha-dl-tocopherol, 0.6 g/kg diet) for 65 days before sacrifice. This resulted in a daily intake of 1250 mg/kg/day (vitamin C) and 75 mg/kg/day (vitamin E). Cardiac mitochondrial DNA (mtDNA) of mice treated with AZT had over 120% more oxo-dG (8-oxo-7,8-dihydro-2'-deoxyguanosine, which is a biomarker of oxidative damage to DNA) in their mitochondrial DNA than untreated controls. AZT treatment also caused an increase in mitochondrial lipid peroxidation and an oxidation of mitochondrial glutathione. Dietary supplementation with supranutritional doses of the antioxidant vitamins C and E protected against these signs of mitochondrial oxidative stress. The oxidative effects of AZT are probably due to an increase in production of reactive oxygen species by mitochondria of AZT-treated animals, raising the possibility that oxidative stress may play an important role in the cardiotoxicity of AZT. --- TC > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=15215767&query_hl=2 > [quoted text clipped - 24 lines] > > TC also: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=11362186&query_hl=8 Some vitamins associated with decreased risk of AIDS and death. [No authors listed] AIDS: There is evidence presented in a study from Johns Hopkins that dietary intake of certain vitamins is associated with survival and a substantially reduced risk of progression to AIDS. The results must be interpreted with caution for the following reasons: 1)the data are not from clinical trials but from an observational study; 2)food intake was assessed only at the beginning of the six year study; and 3)the possible misunderstanding of research results by the public, leading to megadose vitamin supplementation. The study drew its results from a study of a cohort of 5,000 gay men in 4 cities. Dietary and vitamin supplement intake was determined and the group divided into quartiles based on the amount of nutrient intake. The differences in progression to AIDS or death between high and low users of particular supplements was given as "relative hazard". The results suggest that high intake of several nutrients (niacin, vitamin C, and vitamin B1) were associated with slower progression to AIDS. Vitamin A may have a U-shaped relation with risk of AIDS. Increasing zinc was associated with more rapid disease progression. For beta carotene, the third quartile of intake was associated with increased survival. The observational study cannot prove that supplements are causing the changes in progression to AIDS and in survival. To get definitive proof will require clinical trials. However, such trials may never be conducted due to uncertain government financial support and lack of pharmaceutical interest in research which does not sell a product. ------- TC > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=15215767&query_hl=2 > [quoted text clipped - 24 lines] > > TC also: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=11029606&query_hl=8 Virological and immunological effects of antioxidant treatment in patients with HIV infection. Muller F, Svardal AM, Nordoy I, Berge RK, Aukrust P, Froland SS. University of Oslo, The National Hospital, Rikshospitalet, Oslo, Norway. fredrik.muller@labmed.uio.no BACKGROUND: Intracellular oxidative stress in CD4+ lymphocytes due to disturbed glutathione homeostasis may lead to impaired lymphocyte functions and enhanced HIV replication in patients with HIV infection, especially in those with advanced immunodeficiency. The aim of the present study was to assess whether short-term, high-dose antioxidant treatment might have effects on immunological and virological parameters in patients with HIV infection. MATERIALS AND METHODS: In this pilot study, we examined virological and immunological effects of antioxidant combination treatment for 6 days with high doses of N-acetylcysteine (NAC) and vitamin C in 8 patients with HIV infection. The following were assayed before, during and after antioxidant treatment: HIV RNA plasma levels; numbers of CD4+, CD8+, and CD14+ leukocytes in blood; plasma thiols; intracellular glutathione redox status in CD4+ lymphocytes and CD14+ monocytes; lymphocyte proliferation; lymphocyte apoptosis and plasma levels of tumour necrosis factor (TNF)alpha; soluble TNF receptors and neopterin in plasma. RESULTS: No significant changes in HIV RNA plasma levels or CD4+ lymphocyte counts in blood were noted during antioxidant treatment in the patient group. However, in the 5 patients with the most advanced immunodeficiency (CD4+ lymphocyte counts < 200 x 106 L(-1)), a significant rise in CD4+ lymphocyte count, a reduction in HIV RNA plasma level of 0.8 log, an enhanced lymphocyte proliferation and an increased level of intracellular glutathione in CD4+ lymphocytes were found. No change in lymphocyte apoptosis was noted. CONCLUSIONS: Short-term, high-dose combination treatment with NAC and vitamin C in patients with HIV infection and advanced immunodeficiency lead to immunological and virological effects that might be of therapeutic value. ---- TC > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=15215767&query_hl=2 > [quoted text clipped - 24 lines] > > TC also: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=10201796&query_hl=8 Nutritional status of HIV-1 seropositive patients in the Free State Province of South Africa: anthropometric and dietary profile. Dannhauser A, van Staden AM, van der Ryst E, Nel M, Marais N, Erasmus E, Attwood EM, Barnard HC, le Roux GD. Department of Human Nutrition, University of the Orange Free State, Bloemfontein, South Africa. OBJECTIVE: To evaluate the nutritional intake and status of HIV-1 seropositive patients, as well as the relationship between malnutrition and disease stage. DESIGN: A cross-sectional study. SETTINGS: The Immunology Clinic at the Pelonomi Hospital in Bloemfontein, South Africa. SUBJECTS: Eighty-one HIV/AIDS patients in different stages of disease were recruited consecutively from January to May 1995. Eleven of these patients were followed in 1997. MAIN OUTCOME MEASURES: Anthropometric data including current weight, height, triceps skinfold thickness, mid-upper-arm circumference, body mass index and bone-free arm muscle area were collected. Nutrient intake was estimated using a diet history in combination with a standardised food frequency questionnaire. The patients were divided into 3 groups according to their CD4+ T cell counts. RESULTS: The men were leaner (BMI = 18.9) than the women (BMI = 22.7) and patients with a CD4+ T cell count < 200 (stage III) tended to have the lowest median values for all anthropometric measurements. More than half the patients had a low intake (< 67% of the recommended dietary allowances) of vitamin C, vitamin B6, vitamin D, vitamin A, calcium, iron and zinc. CONCLUSIONS: The results confirms that HIV/AIDS patients from this population are malnourished. There was, however, no association between disease stage and nutritional status. Nutritional supplementation of HIV/AIDS patients should be considered, as this might lead to improved immune function in these patients. --- TC >>After controlling for other factors, HIV-infected participants with CD4(+) T cells >/=500 had decreased iron intake (P<.05) and tended to be associated with lower intakes of vitamins C and E (P<.10) compared with those with more advanced disease and HIV-uninfected youths. Among those youths with CD4(+) T cells between 200 and 499 cells/microL, a high anxiety score was associated with a sixfold increase in vitamin A intake as compared with those with a low score<< COMMENT: So anxious people take vitamins. This is news? As for the rest, it's a completely uncontrolled study of people who know very well whether they are HIV pos or neg, and probably in many cases what their progression is. Did they control for supplement use? > >>After controlling for other factors, HIV-infected participants with CD4(+) T cells >/=500 had decreased iron intake (P<.05) and tended to be associated with lower intakes of vitamins C and E (P<.10) compared with those with more advanced disease and HIV-uninfected youths. Among those youths with CD4(+) T cells between 200 and 499 cells/microL, a high anxiety score was associated with a sixfold increase in vitamin A intake as compared with those with a low score<< > [quoted text clipped - 5 lines] > know very well whether they are HIV pos or neg, and probably in many > cases what their progression is. Did they control for supplement use? Did you even read the post? Why do you even bother? You are a waste of bandwidth. TC >>Did you even read the post? Why do you even bother? You are a waste of bandwidth. << The question is whether YOU read it. The Kruzich abstract does not say specifically if they controlled for supplement use, or even if there was supplement use. Here's your chance to take the Kruzich abstract you posted, and show in detail that it answers the question I asked, but that I misread it. SBH > >>Did you even read the post? Why do you even bother? You are a waste of > bandwidth. << [quoted text clipped - 6 lines] > > SBH I said nothing about supplements, or whether they controlled for it or not, or whether there was supplement use or not. Why would it matter if the Kruzich abstract said anything about that or not. And why would you waste time attacking me on something I did not say which has no relevance to the abstract posted in the first place? I headed my post with "HIV and vitamins (specifically vitamin C)". And here are the conclusions in the abstract: "Applications/conclusions Given the increased micronutrient requirements, nutrition counseling with HIV-infected youths should focus on early increase of intake of foods rich in micronutrients to improve growth, slow disease progression, and increase survival." Where did *I* say anything about frikkin' supplements? Show me where I said anything about supplements in this post. You are a complete idiot. Read the frikkin' post. TC >>And here are the conclusions in the abstract: >Applications/conclusions Given the increased micronutrient requirements, nutrition counseling with HIV-infected youths should focus on early increase of intake of foods rich in micronutrients to improve growth, slow disease progression, and increase survival << COMMENT: There is nothing in the abstacted study which shows or even gives good evidence that "an early intake of foods rich in micronutrients improves growth, slows disease progression, or increases survival with HIV." That's a nice idea, but this study does not prove it or even good quality evidence for it. This is a cross sectional epidemiologic study with small numbers. Such things may identify correlations (most of which are spurious) but are otherwise of little power. >>Where did *I* say anything about frikkin' supplements? Show me where I said anything about supplements in this post. << Here is the exchange: Harris: >>Did they control for supplement use? TC: >>Did you even read the post? Why do you even bother? You are a waste of bandwidth. << Naturally I thought that your response to my question was in answer to my question. If on the other hand, you were just babbling, then fine. If you don't like responses like mine, then stop making responses like yours. Yes, I read the post. The answer isn't there. >>You are a complete idiot. Read the frikkin' post. << Thanks, I did. The complete idiot here is you. Don't post abstracts if you don't want comments on them. That's how it works on usenet. SBH > >>And here are the conclusions in the abstract: > [quoted text clipped - 33 lines] > > SBH I'm just yanking your chain. I posted several studies that all point to similar conclusions. That being that nutritional status is important in the treatment and management of AIDS. Anyone who disputes such a basic comonsensical concept like nutrition being important in the management of infectious diseases needs to get himself some basic education. TC > > >>And here are the conclusions in the abstract: > > [quoted text clipped - 45 lines] > > TC That's not what he is saying. One laboratory marker for malnutrition is total lymphocyte count and yes it is important for combating infections. >>Anyone who disputes such a basic comonsensical concept like nutrition being important in the management of infectious diseases needs to get himself some basic education. << COMMENT: I wouldn't dispute the basic idea, though the devil is in the details. For example, you can't just willy nilly supplement everybody with an infection with everything. You don't want to give people with active bacterial infections supplemental iron, for example. And there's a fair literature to suggest that supplements of vitamin E are immunostimulants to a point, and doses over that probably are mildly immunosuppressive and antiinflammatory. Inflammation is bad for people with arthritis, but it's a mixed bag for people with infections (sometimes being good, sometimes bad-- you need it JUST right). So it may not be a good idea to load everybody with an infection up on the max dose of every anti-inflammatory antioxidant vitamin you can think of, either. And so on. SBH > >>Anyone who disputes such a basic comonsensical concept like nutrition > being important in the management of infectious diseases needs to get [quoted text clipped - 5 lines] > For example, you can't just willy nilly supplement everybody with an > infection with everything. Why would you not want to supplement nutrients where it is lacking? And supplementing is only one way to ensure optimum nutrition. Why would doctors not try to ensure that the patients are getting the freshest and the most nutritious foods possible under the circumstances? And obviously you do not supplement where it is contra-indicated. You don't want to give people with active > bacterial infections supplemental iron, for example. And there's a fair > literature to suggest that supplements of vitamin E are > immunostimulants to a point, and doses over that probably are mildly > immunosuppressive and antiinflammatory. The problems with fat soluble vitamins occur only in the refined supplements. Why not supplement with proven safe whole-food-source products like cod liver oil? Or just the appropriate foods. It does not have to be supplements, it could easily be real whole foods in the right amounts. Inflammation is bad for people > with arthritis, but it's a mixed bag for people with infections > (sometimes being good, sometimes bad-- you need it JUST right). So it [quoted text clipped - 3 lines] > > SBH The idea is not to willy-nilly load up on any and all "anti-inflammatory antioxidant vitamin you can think of", the idea is to become familiar with and study closely the various nutrients available and needed and their various forms, from real food forms to pill forms, and use them to assure the best nutritive state for the patient in the most practical manner. Part of that is also clearly understanding the roles of these vitamins in basic human health. Once a nutritional assessment is done and some modicum of optimum nutritional status is re-established or in the process of being established, then you can consider additional treatment options such as pharmaceuticals, surgeries, etc. It makes so much sense to simply be aware of the nutritional status of the patient and to correct any nutritional deficiencies or to optimize the amounts of specific nutrients before or at the time that other treatments are considered. As it stands, doctors almost completely ignore nutritional deficiencies and the resultant effects on the patients health, their ability to recover, and their ability to tolerate the various treatments, etc. In this area of basic nutrition, doctors are completely incompetent and see no need to be any more competent than they are. Imagine trying to straighten the crooked walls of a house without even considering whether or not the foundation is in proper condition. Imagine the contractor laughing at you and calling you a quack or a screwball for even suggesting that there may be a problem with the foundation. Yet, that is what doctors do in terms of nutrition and its primary importance to the treatment of chronic conditions. They jump right into all kinds of physically invasive treatments (and I include pharmaceuticals as physically invasive treatments) without even remotely considering the possibility of assessing or optimizing the nutritional status of the patient as a part of the treatment. TC >>As it stands, doctors almost completely ignore nutritional deficiencies and the resultant effects on the patients health, their ability to recover, and their ability to tolerate the various treatments, etc.<< COMMENT Sadly, I agree. It's a major deficit in the way medicine is practiced. Until you'd made a valiant attempt to make sure your patient is well-nourished, you shouldn't be messing about with drug treatment of any chronic problem which can wait a bit. That's been a practice of mine for decades. >> In this area of basic nutrition, doctors are completely incompetent and see no need to be any more competent than they are.<< COMMENT: Here you will be surprised that I also agree. With the important proviso that I see nobody out there much better. Trained nutritionists are somewhat better at devising diets which supply the essential nutrients in reasonable quantities, but nutritionists, even the full "metabolic team," spend little time in figuring out whether their prescriptions actually do what is needed! For most of these things (half a hundred nutrients the body needs), there's no feedback! A few macronutrients (protein/nitrogen) are tracked, and a very few vitamins (B12) and electrolytes routinely have blood levels measured, in standard medicine. For the rest of it, we really have little good idea what is the relationship between nutrients and disease, because the interventive studies have not been done (due to lack of funding), and the epidemiological studies provide data too complex to sort out. But it's not like the alternative crowd measures these things, either! And when they do, they do it in hair or something and it's complete hokum. Yes, there's a large group of people thowing every nutrient you can think of, at every problem you can think of. But they're not measuring blood levels of appropriate vitamers (your chiropractor getting 25-OH vitamin D levels-- no, I don't think so) or metabolic markers either (this can get EXPENSIVE) and they're not collecting good randomized prospective statistics on efficacy. So what they do is not captured in scientific knowlege. It's impossible to tell if they do any good. Some of them might be. Some of them surely aren't. But they work in the dark with treatments they only half guess might be efficacious, and there's not enough there to say whether it's a useful addition to medicine or not. Some nutritional therapies are beginning to see the light (long chain w-3 treatment) and they provide a glimpse of things to come. But they are few and far between, and embedded in an awful lot of voodoo. As an often cited example, I've been seeing "alternative medicine" shoving vitamin E down people for 25 years, now. It doesn't work any better now than it did then. All we know after 25 years about vitamin E is how much it does NOT work for many of the things it was most claimed to work for (cardiovascular disease, aging). That's an example of something all the alternative people "knew", and ridiculed doctors for not knowing, which they really didn't know at all. "It ain't the things you don't know that hurt you, so much as the things you know, that just aren't so." (Josh Billings). SBH Someone posted: >As it stands, doctors almost completely ignore nutritional deficiencies and the resultant effects on the patients health, their ability to recover, and their ability to tolerate the various treatments, etc. "Sbharris[atsign]ix.netcom.com" <sbharris@ix.netcom.com> replied: > Sadly, I agree. It's a major deficit in the way medicine is practiced. IOW, medical schools do not teach "baseline" (diet / nutritional) medicine to their med students. So any real "health nut" may know more "baseline" (diet / nutritional) medicine than their M.D.? > Until you'd made a valiant attempt to make sure your patient is > well-nourished, you shouldn't be messing about with drug treatment of > any chronic problem which can wait a bit. That's been a practice of > mine for decades. But really how many M.D.s really do that? Maybe, I needs to become their own de facto baseline (diet & nutritional) medicine "doctor."? > In this area of basic nutrition, doctors are completely incompetent and see no need to be any more competent than they are "Sbharris[atsign]ix.netcom.com" <sbharris@ix.netcom.com> replied: > Here you will be surprised that I also agree. With the important > proviso that I see nobody out there much better. Trained nutritionists Naturopathic doctors are. N.D.s know that the ROOT cause of many cases of ear infections and strep throats is their patient drinking cow's milk. "Sbharris[atsign]ix.netcom.com" <sbharris@ix.netcom.com> replied: > often cited example, I've been seeing "alternative medicine" shoving > vitamin E down people for 25 years, now. It doesn't work any better > now than it did then. All we know after 25 years about vitamin E is > how much it does NOT work for many of the things it was most claimed to > work for (cardiovascular disease, aging). That's an example of Perhaps, "real" Vitamin E needs to be used? Including all 8 forms of "real" Vitamin E? "Sbharris[atsign]ix.netcom.com" <sbharris@ix.netcom.com> replied: > something all the alternative people "knew", and ridiculed doctors for > not knowing, which they really didn't know at all. "It ain't the things > you don't know that hurt you, so much as the things you know, that just > aren't so." (Josh Billings). I disagree. It is the thing that most M.D.s don't know that hurts the doctor's patient: Like most M.D.s NOT knowing that the ROOT cause of many cases of ear infections and strep throats is their patient drinking cow's milk. So the patient continues to suffer by NOT being told about the possible adverse health effects of drinking cow's milk from their M.D. |
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