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►Trace-Element
Analysis |
►Trace
element |
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►Trace
element description |
►TRACE
ELEMENTS |
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►Trace
Element and Micronutrient |
►Trace Element Analysis |
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►Trace Element Research
Laboratory |
►Trace
Element Detection |
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►Vitamins,
Minerals, and Trace Elements |
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Trace Element Research
Laboratory |
The Trace Element
Research Laboratory (TERL)
has world-class capabilities
for elemental chemical
measurements for an
incredibly wide variety of
applications in earth,
environmental, chemical,
biological, medical and
materials sciences. Superb
expertise and state of the
art inductively coupled
plasma based optical
emission and mass
spectrometry instruments are
available. Most of the
elements in the periodic
table (other than C, N, O, F
and noble gas elements) can
be measured at
concentrations from major
(%) to ultratrace (part per
trillion). Measurements can
be made on solution samples,
solids following digestion
or, using laser ablation
sampling, directly on
solids.
The TERL provides facilities
and expertise to
researchers, students and
faculty throughout The Ohio
State University in variety
of ways. Properly trained
researchers, students and
faculty can use the
facilities independently or
in collaboration with our
staff. On the other extreme,
TERL staff discuss research
or analyses problems of
interest with faculty,
students or clients, design
the appropriate
measurements, make the
measurements and provide
analysis results.
Our mission includes
teaching of the fundamental
concepts and practical
measurement techniques
through traditional courses,
short courses and one-on-one
sessions. The TERL
encourages faculty to use
the facilities and staff
expertise in their teaching
activities.
We also provide services and
expertise to other
Universities, government
organizations, individuals
and industry at rates on a
par with commercial
laboratories with a special
emphasis on unique method
development and problem
solving. |
| Article Source: |
| http://www.geology.ohio-state.edu/marc/ |
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Trace Element Analysis |
The Trace Element
Analysis (TEA) laboratory
specializes in low-level
trace metal analysis and
speciation in environmental
and biological samples. We
use inductively coupled
plasma mass spectrometry (ICP-MS)
for metals analysis and
several “hyphenated”
techniques that couple
instruments together for
speciation analyses of
water, soil and biological
tissue samples.
The lab has three ICP-MS
instruments (Agilent 7500c,
Agilent 7500cx, and Element
2 ICP-MS). We can measure
most elements in the
periodic table with
detection limits in the low
ppt range or below.
Our ICP-MS instruments can
also be coupled with cold
vapor generation, liquid
chromatography and laser
ablation. With these
hyphenated analyses we can
Detect ultra-low levels of
arsenic or mercury (< 1 ng/L)
Differentiate between toxic
and nontoxic forms, or
species, of arsenic and
mercury
Map trace elements within a
biological tissue
We are interested in new
methods and new applications
for hyphenated analyses.
This includes work in the
emerging field of “metallomics,”
which characterizes all of
the metal binding molecules
in a cell, in blood, or in
an organism.
The TEA lab supports
Dartmouth College
researchers in the Superfund
Basic Research Program:
Toxic Metals in the
Northeast. We work
especially closely with
Superfund Basic Research
Program Project 4
Epidemiology, Biomarkers and
Exposure Assessment of
Metals and Project 7
Bioaccumulation and Trophic
Transfer of Toxic Metals in
Aquatic Food Webs. For
Project 4, we speciate
arsenic and provide total
concentrations from samples
of water and urine. For
Project 7, we measure levels
of mercury and other metals
in freshwater aquatic food
webs. |
| Article Source: |
| http://www.dartmouth.edu/~toxmetal/resources/cores/analysis/index.html |
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Trace-Element Analysis |
Trace-Element Analysis
at the IsoTrace Laboratory
with emphasis on the
platinum group elements.The
University of Toronto is
well-known as one of the
first laboratories to do
radionuclide AMS. The
existing AMS facility has
also been used for a number
of years for in-situ AMS
measurements of Au, Ag, and
platinum group elements in
mineral grains and
meteorites (Rucklidge et
al., 1981, 1982; Wilson et
al. 1990; Rucklidge et al.,
1990a, 1990b; Kilius et al.,
1990; Wilson et al., 1991;
Rucklidge et al., 1992;
Wilson et al., 1995, 1997a,
1997b, 1997c; Wilson, 1998;
Sharara et al., 1999; and
Litherland et al., 2000).
The "heavy-element" program
developed at IsoTrace had
its beginnings in the
fertile period of
collaborative research at
NSRL in Rochester, circa
1977-1981, which saw trial
analyses of platinum-group
elements (PGE) such as Ir
and Pt in pressed, powdered
targets of rock and mineral
samples, using a broad-beam
Cs+ source on the MP tandem
accelerator. Further
development at IsoTrace was
slow, but sped up in the
late 1980s with the
evolution of a multi-target
sample-mount format which
involved the drilling of
small (4-mm-wide)
cylindrical "mini-cores" of
samples and reference
materials which were then
mounted in sets of 12 in a
25-mm circular holder and
polished to a fine finish,
permitting mineralogical or
metallographic tests prior
to analysis (see
illustration).
It should be noted that the
sample chamber and 25 x
25-mm micron-resolution
stage came first, in 1984,
in order to combine
unrestrained 3-D mobility
and adequate sample-viewing
optics, essential features
for analysis of targets such
as rocks. Rocks are almost
always heterogeneous
mixtures of one or more
mineral species of variable
shapes and grain sizes. The
initial work conducted on
the new stage was again of
the pressed-powder variety,
but the move to solid
targets promoted a spate of
measurements and rapid
progress from circa 1989 to
1997, as summarized below.
The principal limitations of
the technology (aside from
questions of cost and
availability) which have
thus far restricted adoption
of these methods are
perceived to be 1) the need
to use conducting targets,
whereas common rock-forming
minerals are mostly good
insulators and 2) the broad
Cs+ beam size (maximum range
maybe 250 - 1500 microns,
but commonly circa 1000
microns) which limits
application to relatively
coarse-grained samples. If
any group succeeds in going
beyond these constraints,
which are common to
14C-oriented accelerator
labs, the next question will
probably return to
quantitation and the
development of reference
materials. In the course of
this work, IsoTrace has
addressed this by
fabricating "fire assay"
beads based on dissolution
of well-characterized
samples into a conducting
nickel sulphide matrix.
Possible applications of
trace-element AMS are almost
limitless, if the questions
of surface charge build-up
and spatial resolution can
be addressed at a facility
with a flexible analytical
repertoire. Analytical
capability evolved at
IsoTrace due to the efforts
of the late Linas Kilius and
the other lab staff, but did
not exist in the very first
incarnation of the lab, a
straightforward 14C system.
Although test measurements
were made on semiconductors,
the vast majority of
trace-element data at
IsoTrace have involved
conducting minerals and
metals in rocks, meteorites
and archaeological
artifacts. In addition, a
large majority of the
measurements have centered
on just eight elements, the
precious metals, namely Au
and Ag and the six platinum
group elements (PGE; Pt, Ir
and Rh, which form negative
ions readily, and Pd, Ru and
Os, for which sensitivity is
significantly lower).
Typical detection levels
achieved in short (e.g. 10
to 200 second) counting
times are given in Table 1.
Approximately 40 elements
have been the subject of
basic research at IsoTrace
(see Heavy Element Research)
but the precious metals have
dominated the applications
work.
It is important to note that
in-house research has
emphasised the importance of
collecting AMS data as part
of a broad spectrum of
research on a topic. This
ideally includes collection
of samples in the field,
classic petrographic
(microscopic) studies, and
sometimes whole-rock
analyses of bulk samples
plus collection of
mineral-chemical data for
major to trace elements
using a full range of
methods; some combination of
electron, proton and ion
microprobe analyses as well
as the broad-beam AMS.
The PGE and Au typically
behave as siderophile or
chalcophile (iron- or
sulphur-loving) metals,
present at low ppb levels or
below in the Earth's crust,
but at much higher levels in
many meteorites and (by
inference) in the cores of
the differentiated
terrestrial planets. An
enrichment factor of roughly
1000 is necessary to elevate
the PGE content of typical
crustal rocks from ppb
levels to the ppm grades
which constitute ore in most
hard-rock gold and platinum
mines today. The AMS of
precious metals has largely
been directed to the
following materials: common
(Fe-Cu-Ni-As) sulphides,
(Fe-Ti-Cr) oxides, copper
(both natural native copper
and refined metal), the
common (Fe-Ni-Co) metal
phases in iron meteorites,
and graphite. These
materials have been analysed
in three broad contexts;
1. Distribution of the
metals amongst coexisting
ore minerals in various
classes of mineral deposit.
All the precious metals may
occur both in concentrated
form (rare minerals such as
Au, PtFe, PtSn, PdBiTe, PdSb,
etc) and `invisibly' within
the crystal structures of
common ore minerals at
levels from <1 ppb to 100
ppm or more - much more in
the case of Ag.
2. Chemistry of iron
meteorites, where the PGE
and Au must occur dispersed
amongst a generally small
number of reduced phases;
Ni-Fe alloys, phosphides,
carbides, FeS and graphite.
3. Provenance of
archaeological metals. Thus,
smelted Cu of European
derivation has been shown by
INAA, AMS and humble
petrographic methods to be
distinct from the purer
native copper recovered for
perhaps seven millennia by
the inhabitants of the Great
Lakes region. As with
natural materials, samples
must be characterized by
context and microscopic
properties prior to
analyses, which may include
14C-dating of suitable
components.
In terms of trace-element
work, the most important
research at IsoTrace since
1997 has been method and
equipment development by
graduate students (see
Current Graduate Studies
Research). In the geological
context, the work of Ilia
Tomski and Jonathan Doupé
promises to broaden the
range of available
analytical strategies, while
Jenny Krestow's project
addresses the fundamental
problem of analysing
insulating targets,
including common minerals
such as olivine and quartz.
Table 1: Standard detection
levels for some trace
elements in parts per
billion for analysis times
less than 200 seconds. If
required, lower detection
levels can be obtained with
increased analysis time,
limited by the availability
of material.
| Element |
Detection level |
for element
|
| & symbol |
(parts per
billion) |
(atoms/cm3) |
| Gold (Au) |
______0.005____ |
_____8.0E10____ |
| Silver (Ag)
|
______0.05_____ |
_____1.4E12____ |
| Platinum (Pt)
|
______0.1______ |
_____1.5E12____ |
| Iridium (Ir)
|
______0.25_____ |
_____3.9E12____ |
| Rhodium (Rh)
|
______0.5______ |
_____1.5E13____ |
| Palladium (Pd)
|
______4________ |
_____1.1E14____ |
| Ruthenium (Ru)
|
______4________ |
_____1.2E14____ |
| Osmium (Os)
|
_____20________ |
_____3.2E14____ |
Note. Detection levels
and data in a mineralogical
context are normally
presented as parts per
billion, parts per million
or percent (by weight) in
the relevant matrix. The
detection levels in
atoms/cm3 are calculated for
a target of pyrite ("fool's
gold", the most familiar
sulphide mineral, ideal
formula FeS2), a cubic
compound with specific
gravity 5.01.
Pyrite, familiar to
mineralogists,
crystallographers and other
materials scientists, is a
representative target for
geological studies. Pyrite
containing arsenic as an
impurity to the percent
level is a noted host
mineral for gold, at levels
which in exceptional cases
may exceed 1000 ppm (0.1
wt.%). Nominal specific
gravities for ten
representative target
minerals are as follows;
graphite (2.2), chalcopyrite
(4.2), pyrrhotite (4.6),
pentlandite (4.8), chromite
(4.8), pyrite (5.01),
magnetite (5.18),
arsenopyrite (6.1), kamacite
(7.85) and native copper
(8.95). |
| Article Source: |
| http://www.physics.utoronto.ca/~isotrace/isowtrel.html |
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Trace element |
From Wikipedia, the free
encyclopedia
Jump to: navigation, search
In analytical chemistry, a
trace element is an element
in a sample that has an
average concentration of
less than 100 parts per
million measured in atomic
count, or less than 100
micrograms per gram.
In biochemistry, a trace
element is a chemical
element that is needed in
minute quantities for the
proper growth, development,
and physiology of the
organism.[1] In
biochemistry, a trace
element is also referred to
as a micronutrient.
In geochemistry, a trace
element is a chemical
element whose concentration
is less than 1000 ppm or
0.1% of a rock's
composition. The term is
used mainly in igneous
petrology. |
| Article Source: |
| http://en.wikipedia.org/wiki/Trace_element |
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TRACE ELEMENTS |
Since 1984 Trace
Elements has been recognized
internationally as a leading
provider of HTMA laboratory
services and nutritional
metabolic products for
doctors and health
professionals of all
specialties worldwide.
Through exclusive
distribution agreements and
direct-client associations,
Trace Elements serves health
professionals exclusively in
over 46 countries.
Trace Elements continues to
demonstrate our full
commitment to the principles
of ultimately serving the
patient by best supporting
you, the clinician. Through
unrelenting attention to
excellence in laboratory
testing, related services,
doctor education and
continuing nutritional
research, Trace Elements
mission is to continually
assist in improving patient
care and response to
treatment for those we
serve. |
| Article Source: |
| http://www.traceelements.com/ |
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Trace element
description |
Trace element also
called Micronutrient.
in biology, any chemical
element required by living
organisms in minute amounts,
usually as part of a vital
enzyme, a cell-produced
catalytic protein. Exact
needs vary among species,
but commonly required plant
micronutrients include
copper, boron, zinc,
manganese, and molybdenum.
Animals also require
manganese, iodine, and
cobalt. Lack of a necessary
plant micronutrient in the
soil causes plant deficiency
diseases; lack of animal
micronutrients in the soil
may not harm the plants,
but, without them, animals
feeding solely on those
plants develop deficiency
diseases. |
| Article Source: |
| http://www.britannica.com/EBchecked/topic/601406/trace-element |
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Trace Element and
Micronutrient
|
The Trace Element and
Micronutrient Unit at
Glasgow Royal Infirmary,
Glasgow, UK offers
specialised analytical
services and interpretation
of results to medical
practitioners, hospital
clinicians, dentists,
employment medical advisers
and others requiring
investigation of a range of
nutritional and
toxicological problems
involving trace elements and
vitamins. The Unit is
supported by central funding
from the National Services
Division of the NHS in
Scotland.
This web-site provides a
guide to the services
offered, with useful
background information:-
An outline of the different
type of services offered,
with specific information on
micronutrients, monitoring
water for dialysis and
mercury monitoring for
dental staff
A short tutorial on trace
elements
Information on specific
trace elements from
aluminium to zinc with
details of sample
requirements and reference
ranges
A summary of research in the
Unit
Information on how to
contact us
Links to other sites
An on-line converter for
blood lead results from 祄ol/l
to 礸/100 ml and vice-versa
using Javascript.
The laboratory in pictures
showing the staff and
equipment in analytical
procedures. |
| Article Source: |
| http://www.trace-elements.org.uk/ |
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Trace Element
Detection |
Any of a number of
elements required by living
organisms, in small amounts,
to ensure normal growth,
development, and
maintenance. They do not
include the basic elements
of organic compounds
(carbon, hydrogen, oxygen,
and nitrogen) or the other
major elements present in
quantities greater than
about 0.005% (calcium,
phosphorus, potassium,
sodium, chlorine, sulfur,
and magnesium). See
essential element.
Elements found in the human
body. The most abundant
elements in the body (red),
lesser elements (blue), and
trace elements (green).
Trace elements found in the
human body are iron,
manganese, zinc, copper,
iodine, cobalt, molybdenum,
selenium, chromium, silicon,
fluorine, vanadium, nickel,
arsenic, and tin. See also
elements, biological
abundance.
Because living things serve
to locally concentrate trace
elements, accumulations of
these elements in rocks
serve as biomarkers which
astrobiologists will be able
to use in their search for
extraterrestrial life.
Biological Trace Element
Research is today's leading
forum for original papers in
biological, environmental,
and biomedical research on
trace elements. This
interdisciplinary journal
stresses the integrative
aspects of trace element
research in all relevant
fields, especially focusing
on nutritional studies in
humans and in animal models.
BTER elucidates the relevant
aspects of preventive
medicine, epidemiology,
clinical chemistry,
agriculture, endocrinology,
animal science,
pharmacology, microbiology,
toxicology, virology, marine
biology, sensory physiology,
developmental biology, and
related fields. It provides
extensive coverage of human
health problems caused by a
deficiency or excess of
trace elements in human
diets. |
| Article Source: |
| http://www.daviddarling.info/encyclopedia/T/traceelement.html |
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Vitamins, Minerals, and
Trace Elements |
To understand the role
of vitamins and minerals, it
helps to understand a little
bit about the chemistry of
your body. Living organisms
rely on highly complex
processes to perform and
regulate those internal
functions that are necessary
to maintain life. Processes
are in place to
Build the cells that make up
your body's structures
Meet the separate needs of
different types of cells
Permit each of these
different cell types to
carry out its own specific
functions
Help maintain cellular
structure and performance
Alter the type and degree of
cellular activity in the
face of changing
circumstances
Communicate and coordinate
each cell's activity with
the activity of other cells
and organs in the body
Adjust cellular behavior, as
needed, in ways that will
permit a coordinated
response of the whole
organism to its environment
Dispose of waste products
Govern the disposal of cells
when their job is done
The scientific term we use
to describe all this is
homeostasis.
Homeostasis can be defined,
then, as the ability of a
living organism to maintain
its structure and function
intact, separate from and
invulnerable to the forces
of its environment.
AdvertisementThe maintenance
of homeostasis is highly
complex, requiring many
series of chemical
reactions, distinct and yet
interrelated. Each step in
each reaction requires the
presence of specific
substances, often in minute
amounts. If these materials
are not present, or are
present in too small a
quantity to perform their
roles, the reactions that
require them cannot proceed
correctly.
Vitamins, minerals, and
trace elements are among
these necessary substances.
With the exception of
vitamin D, which can be made
within the skin, they cannot
be made in the body; they
must be absorbed to be
obtained. Some are produced
for us within the gut, by
bacteria that live there.
We don't need a lot of them.
Given perfect health and a
well-balanced diet, we can
get what we need from the
food we eat. Given states of
altered metabolism, though,
we may need more. And during
or following an illness, the
body's natural processes of
healing and repair cannot go
forward unless we have
enough-sometimes more-of the
vitamins required.
There is evidence which
raises the possibility that
higher amounts of some of
these substances may
actually improve our health
even when we're not sick, by
giving our bodies a richer
source of materials to draw
on in the face of normal
stress. This view is
controversial, but more and
more research supports it.
HIV and Vitamin, Mineral,
and Trace Element
Deficiencies
In HIV, as in normal aging,
some evidence suggests that
we may benefit from more of
some of these elements than
we normally get from our
diet or than was previously
recommended. In addition,
many people with HIV have
been shown to have actual
vitamin deficiencies-lower
body stores of some vitamins
than what is considered
necessary even for a person
in perfect health.
In some cases, the HIV virus
itself can benefit directly
from those deficiencies,
increasing the rate of its
production. That means it's
critical to avoid these
deficiencies. It also offers
hope for increasing our
gains in the battle against
HIV production in our own
bodies.
As we have seen, HIV
infection can cause you to
eat less. Also, you may
absorb nutrients less well.
This is part of the reason
for HIV-associated vitamin
and mineral depletion.
Many vitamins, minerals, and
trace elements are found to
be deficient or in
low-normal range in people
with HIV. This has been
documented even early in the
course of infection. Even
people who eat an excellent,
well-balanced diet are not
immune to these deficiencies
if they are HIV positive.
Therefore, even apart from
the possible benefits of
higher levels in some
specific cases, it makes
sense to supplement.
Supplementation
The best place to start-as
simple as it seems-is to eat
well. As Dr. Bruce Bistrian,
of the Harvard nutrition
team, puts it, "When we eat
what God gave us, we're
eating what's good for
us.... You got to do it the
hard way." We'll look at
food sources that are
naturally rich in each
particular vitamin as we
discuss it below.
But I don't believe you
should stop there. For you
there is too much at stake.
Therefore, the
recommendations in this
chapter will be for
supplementation-for taking
vitamins daily, in addition
to maintaining a healthy
diet. And if for some reason
you aren't sure your diet is
healthy, supplementing it
can help to protect you
anyway.
Before we look at
supplementation or institute
a program, though, it's
important to talk about RDA.
The RDA, or recommended
dietary allowance, is a
baseline figure. It is used
to suggest the lowest amount
of a given substance that we
should take in, daily, from
our diet. You'll see
references to the RDA on
labels for vitamins and for
many prepared foods.
It's important to understand
that this is not a
recommended intake level.
Rather, it represents the
minimum amount required to
prevent an overt, frank
deficiency-in healthy people
with good absorption and the
ability to maintain normal
nutritional status. Thus the
RDA holds very little
meaning for you.
The RDA underestimates the
requirements of an organism
under stress. It is not a
good guide for your
nutritional or dietary
intake. For vitamin C, for
example, the RDA is 60
milligrams a day-just enough
to prevent scurvy in a
healthy sailor.
The RDA also does not take
into account specific
actions of a given vitamin
that can be of special value
in illness, or may promote
your overall good health.
It's also important to
define our goals for
supplementation. First off,
we don't want to compound
the problems of HIV with the
problems of vitamin
deficiency-but we can do
more than avoid that. We can
improve our bodies' ability
to fight the effects of
injury, disease, and stress
by knowing what can help,
and taking it.
We already know which
vitamins and trace elements
tend to be reduced in HIV
infection. We already have
an idea of the benefits that
higher levels of
supplementation may offer.
And we already know when
it's too much of a good
thing-when vitamin excess
can work against your
health. Popping a good
multivitamin or two each
day, along with a
trace-element supplement,
can be a good start. There
is research in the
literature which shows a
real role for daily vitamin
use. One study showed that
people with HIV did better
just by taking a
multivitamin supplement
every day.
If you want to consider more
specific supplementation-and
I believe you should-some
suggestions follow. For
certain vitamins in
particular, high-dose
supplementation is worth
considering.
Vitamins Which May Be
Deficient in People with HIV
Note that in many cases the
appropriate supplementation
amount simply has not been
determined. Where we don't
know how much of a
particular vitamin can help
you, the RDA is given-just
to give you a rock-bottom
floor. Where we know too
much of a vitamin can hurt
you, this is stated as well.
To understand the minute
quantities that are needed,
you have to know the
relevant units of measure:
1,000 micrograms = 1
milligram
1,000 milligrams = 1 gram
28 grams = 1 ounce
Here are some of the
vitamins you want to pay
special attention to.
Vitamin B1 (Thiamine)
Thiamine is needed for
conversion of carbohydrates
into energy, for
transmission of signals from
your nerves to your muscles,
and for maintaining the
structure of membranes in
the nervous system.
It is absorbed high in the
small intestine and stored
mainly in muscle tissue. Raw
fish, coffee, and tea can
break it down. Deficiency
can occur quickly, as the
body can't store this
vitamin for long.
Malabsorption, malnutrition,
alcohol, diarrhea, and low
folate levels can all
contribute to B1 deficiency.
Antacids and other medicines
that reduce stomach acidity
can destroy it.
Need is increased with
fever, heavy exercise, or
high caloric intake.
Deficiency can result in
weight loss, irritability,
poor appetite, and
paresthesias-the burning or
prickling sensations we
associate with peripheral
neuropathy-especially in the
feet and lower legs. When
deficiency is more severe
there can be weakness and
changes in mental status.
One to two milligrams a day
is said to prevent frank
deficiency. Excess thiamine
goes out in the urine, so
too much can't hurt you.
Most multivitamins contain
1.5 to 3 milligrams of
thiamine. High-potency pills
and B-complex supplements
contain 50 to 100
milligrams.
Dietary sources of thiamine
include red meat, whole
grains, potatoes, peas,
beans, nuts, and yeast. As
this nutrient is
water-soluble, it can be
lost when food is cooked in
liquids.
Vitamin B2 (Riboflavin)
Riboflavin is also absorbed
in the small intestine. It
is needed for many reactions
in the body, and
particularly for the
metabolism-the energy
economy-of amino acids, the
basic units from which
proteins are constructed. It
is also needed to convert
dietary vitamin B6 to its
active form in the body.
Riboflavin deficiency can
develop within a week. Some
drugs can contribute to such
deficiencies: Compazine, or
prochlorperazine (used for
nausea); major
tranquilizers; and tricyclic
antidepressants such as
Elavil, or amitriptyline,
often used for the treatment
of foot pain in HIV, are
among them.
Deficiency can result in
burning and itching eyes,
painful sensitivity to
light, tongue and mouth
pain, anemia, and
personality changes. In
addition, metabolism of
drugs can be altered.
Three milligrams a day are
recommended to prevent
riboflavin deficiency.
Again, if you don't need it,
you excrete it.
Supplementation in standard
multivitamins is in the
range of 1.5 to 3.5
milligrams. High-potency
sources and B-complex
preparations contain 75 to
100 milligrams.
People who supplement their
B2 notice that their urine
shines a bright, fluorescent
yellow. That's why you see
this now, if you're taking a
B-complex supplement.
Natural sources of
riboflavin include dairy
products, meat, fish, and
green leafy vegetables.
Whole grain cereals are also
good sources, as are egg
whites. Riboflavin is broken
down by light, so exposure
while cooking (by broiling,
for instance) can deplete
it.
Vitamin B6 (Pyridoxine)
Pyridoxine is also absorbed
in the small intestine, and
any excess is excreted in
the urine. Deficiency can
develop in two or three
weeks. Like vitamin B2, it
is active in the metabolism
of amino acids. It also
plays a role in making
neurotransmitters-the
chemicals that brain cells
use to communicate with one
another. It is essential to
many enzyme reactions.
Vitamin B6 deficiency is
relatively common in people
with HIV. This has been
reported in the early,
asymptomatic phase of
infection in particular.
Isoniazid, or INH, commonly
used to treat tuberculosis
in people with HIV, further
contributes to B6
deficiency.
Symptoms include
irritability and depression,
followed by skin rashes and
tongue and mouth tenderness.
Nausea and vomiting, as well
as seizures, are late
manifestations. B6
deficiency can also cause
anemia, and it has been
shown to further impair
immune function in people
with HIV.
One study reported that oral
supplements of 20 milligrams
or more a day successfully
corrected deficiencies in
people with HIV. Twenty-five
to 50 milligrams a day is
better if you're taking INH.
Standard multivitamin
preparations contain 2 to 5
milligrams. B-complex pills
can have 5 to 100
milligrams.
Foods rich in B6 include
meat, fish, egg yolks,
beans, fruits, and
vegetables. Liver is a good
source, as are whole grain
cereals. Losses occur during
cooking.
Vitamin B12 (Cobalamin)
Absorption of vitamin B12 is
more difficult than that of
the other B vitamins. Cells
in the stomach produce a
factor which binds to B12
and permits it to be
absorbed in the small
intestine. Thus there are
two points in its journey at
which oral absorption can be
impaired. On the other hand,
the body can recycle some of
what gets in, shuttling it
back and forth between the
intestine and the liver, for
reuptake and reuse. It is
stored in the liver in ample
quantities, so B12
deficiency takes longer to
occur than other B-vitamin
deficiencies.
Nonetheless, B12 deficiency
is common; some studies have
found vitamin B12 levels to
be low in 20 to 25 percent
of people with HIV. Many of
these people showed no
obvious symptoms of
deficiency. Also, it's
harder to detect clinically.
Most HIV-negative people
with B12 deficiency have
changes in their red blood
cells-bigger cells, more
hemoglobin per cell-which
show up easily on a complete
blood count, alerting their
doctors to test B12 levels.
HIV-positive people don't
show this pattern. If their
doctors are not looking
specifically for B12
deficiency, they may never
know it's there. Doctors may
also not consider the
enormous contribution of
malabsorption to HIV
nutritional status and
disease progression, which
might otherwise encourage
them to check B12 levels
automatically. Thus, when
not checked routinely, B12
deficiency can often be
missed.
A low level of vitamin B12
is especially important in
the setting of HIV, because
of its potential role in
problems with nerve
conduction or function
(neuropathy) and spinal cord
abnormalities (myelopathy).
These conditions are seen
with some frequency in the
HIV-positive population, and
they have substantial impact
on quality of life. One
study looked at people with
relatively advanced HIV
disease who were referred to
a university neurology
clinic. These people
presented either with
neuropathy or myelopathy. Of
those who had both
conditions, vitamin B12 was
found to be low in more than
half.
Vitamin B12 deficiency has
also been associated with
early, subtle changes in
mental function in people
with HIV. Those changes
include the speed with which
we process information, and
our performance on tasks
requiring visual-spatial
coordination. Because they
are subtle, we may not pick
these changes up.
Vitamin B12 is provided in
the diet by meat, fish, and
eggs, so vegetarians are
particularly at risk. It can
be obtained in lesser
amounts from milk and milk
products. Generally, it is
not destroyed by cooking.
As with the above vitamins,
there is no specific
recommendation for
supplementing in
HIV-positive people; the
studies just haven't been
done. Your basic
multivitamin has 6 to 18
micrograms of B12. B-complex
preparations include from 12
to 500 micrograms. Separate
B12 oral supplements are
also available, in doses
from 25 micrograms to 1
milligram. An excess of B12
won't hurt you, but it may
not be necessary.
We'll talk more about
vitamin B12 supplementation
later. Because absorption is
so frequently a factor in
B12 deficiency, you may need
some help from your doctor.
Folate
Folate changes into its
active form after it has
been absorbed by the body.
It is excreted through the
gastrointestinal tract. It
is necessary for making red
blood cells and for
neurological function. Thus
deficiencies in folate, as
with vitamin B12
deficiencies, are associated
with neurologic symptoms.
This can be particularly
important to people with
HIV. More folate is needed
in the presence of severe
infection, cancer, and
pregnancy.
One report measured folate
in the cerebrospinal fluid
-- the fluid that bathes the
brain and spinal cord -- in
children infected with HIV.
Results showed a lower level
of folate in that fluid than
in the blood. Thus we may be
folate-deficient where we
need it most, even when we
test in the normal range.
And, as is found with
vitamin B12 deficiencies,
the red-blood-cell changes
normally associated with
folate deficiency are often
not seen in the presence of
HIV.
AZT has been shown to
contribute to folate
deficiency. People taking
AZT are therefore at greater
risk. This is also true of
other commonly used drugs.
Trimethoprim, for example,
part of the drug
trimethoprim-sulfamethoxazole
(Bactrim or Septra), which
is widely used to protect
against pneumocystis
pneumonia, is a folate
antagonist-it directly
blocks folate. So do
pyrimethamine, used for
toxoplasmosis, and
methotrexate, a common
chemotherapy agent.
Phenytoin, or Dilantin, a
popular antiseizure
medicine, blocks absorption
of folate. So do
barbiturates, used by some
doctors for pain control or
to help you sleep.
Alcohol is a special
villain. It also blocks
folate absorption, and
people who regularly use
substantial amounts of
alcohol are often seriously
deficient. Vitamin B12
deficiency can also lower
available folate levels, as
it is needed to change
folate into its active form.
Loss of appetite, nausea,
diarrhea, hair loss, and
mouth and tongue pain can
all be symptoms of folate
deficiency. Fatigue is
common too. As things get
worse, changes in blood
cells may be seen.
Folate deficiencies are
treated with 1 to 2
milligrams a day. One
milligram or less a day is
given thereafter for
maintenance.
Oversupplementation is not
thought to be dangerous.
Leafy vegetables, organ
meats, and yeast are good
dietary sources.
Multivitamin folate levels
are usually set at 4
milligrams. Folate is not
normally included in
B-complex preparations.
Vitamins Not Frequently
Requiring Supplementation in
HIV
You'll see these vitamins
listed on the labels of the
multivitamin supplements you
buy, as well as for sale
separately. It's important
that you know their role.
Supplementing in large
quantities is unnecessary,
and can in some cases be
harmful. Supplementation in
the small quantities used in
standard multivitamin
preparations won't hurt you,
though.
Niacin
Niacin is needed for the
metabolism of proteins,
carbohydrates, and fats. It
is absorbed throughout the
intestine and excreted in
the urine. In large doses,
in HIV-negative people, it
can have beneficial effects
on cholesterol and
triglyceride levels. But
lowering these levels is not
helpful if you are
HIV-positive.
Without serious
malnutrition, we rarely see
nutritionally based niacin
deficiency. Classically,
deficiency has been found
only in people who eat a
corn-based and otherwise
unbalanced diet.
Five to 20 milligrams a day
are enough to protect
against niacin deficiency,
and large amounts may not be
good for you. What you get
in your diet should go a
long way toward meeting your
needs. Beyond that, my
patients stick to what they
get in their multivitamin
pills.
Symptoms of niacin
deficiency include
generalized weakness and
indigestion. Headaches and
insomnia can follow. Severe
deficiency can cause
characteristic skin rashes,
massive and bloody diarrhea,
and even dementia.
Symptoms of supplementation
include flushing and
temporary tingling and
burning sensations.
Oversupplementation can
cause vomiting, diarrhea,
and even fainting, due to a
fast heart rate and low
blood pressure. At very high
doses ulcers, liver damage,
and high blood sugar can
also result. This is not a
vitamin to play around with.
Standard preparations
contain 20 to 30 milligrams,
which is a minimal amount.
B-complex supplements can
contain up to 100
milligrams. Even at that
dose you may get some
flushing and a
characteristic prickling
feeling.
If you can tolerate this, it
won't hurt you; doses
totaling up to 300
milligrams or so a day are
probably okay. But there's
no reason to take it on its
own. In particular, you
should avoid the
time-release preparations.
They are more likely to
damage your liver.
As an HIV doctor, I also
prefer that my patients not
take niacin in substantial
quantities because it
changes the lab values I use
to monitor their health.
Large amounts of niacin,
even if tolerated, will
lower cholesterol and
triglyceride levels-so those
levels no longer tell me
what I need to know.
Sound sources for obtaining
sufficient niacin in the
diet include meat, fish,
eggs, and beans.
Biotin
Biotin is found in most
foods and is absorbed
throughout the gut. Bacteria
in the colon make more.
Therefore, less biotin will
be available if gut bacteria
are destroyed by powerful
antibiotics. It is needed
for metabolism of fats and
carbohydrates. Raw egg
whites contain a substance
which inactivates biotin.
Still, biotin deficiency has
only been seen in severe
malnutrition.
Rashes, muscle pain, and
hair loss are symptoms of
biotin deficiency, as are
nausea and anemia. However,
even in patients maintained
entirely on total parenteral
nutrition or TPN (food
delivered through the veins
for people who can't be fed
otherwise), reports of
deficiency are rare. For
anybody who can eat, the
amount in a normal
multivitamin, about 30 to
300 micrograms, should
suffice. B-complex vitamins
contain 30 to 100
micrograms.
Pantothenic Acid
Easily absorbed and readily
available in the diet,
pantothenic acid contributes
to the metabolism of
carbohydrates and fats and
to making steroids.
Deficiencies are rare and
have only been described in
association with other
vitamin deficiencies.
When deficiency has been
caused experimentally, the
result has been foot
pain-the so-called "burning
foot syndrome." For this
reason, investigators have
tried to treat those
symptoms with 10 milligrams
a day. Success has been
limited, however.
No role has yet been found
for individual
supplementation with this
vitamin. You'll get a
little, about 10 milligrams,
in most routine supplements.
Vitamin B combinations can
have 5 to 75 milligrams.
Vitamin D
Vitamin D is available in
the diet, but the major
portion is produced by skin
synthesis. It is important
for calcium and phosphate
metabolism, and may have a
role in immune function.
Vitamin D deficiencies are
rare, occurring only with
inadequate exposure to
sunlight. There are no
reported cases of vitamin D
deficiency in people with
HIV. Too much vitamin D can
raise your calcium level,
weaken your bones, and lead
to kidney stones. If you
want to ensure that you have
enough vitamin D, don't look
to your vitamins; just go to
the park and lie in the sun.
Vitamin K
Vitamin K occurs in two
forms. It can be obtained in
the diet from green leafy
vegetables and liver.
Bacteria in the gut provide
another form, which is less
active. Vitamin K is stored
in limited amounts in the
liver, where it is used to
make factors that promote
blood clotting. Thus a
vitamin K deficiency can
result in anticoagulation.
If the liver is damaged, it
may not be able to use
vitamin K, even when present
or provided in adequate
amounts.
Malabsorption or the
long-term use of powerful
antibiotics, which sterilize
the gut, can lead to a
vitamin K deficiency. So can
long-term use of TPN. Such
deficiencies respond to
injections of vitamin K, if
the liver is healthy. There
is no report of vitamin K
deficiency peculiar to HIV,
and I know of no need to
supplement it on your own.
Multivitamins don't
generally contain it.
When a deficiency is
documented in people with
long-term malabsorption and
diarrhea, it sometimes will
respond to oral treatment.
This you should discuss with
your doctor.
Antioxidant Vitamins
Antioxidant vitamins play a
central role in regulating
homeostasis. They are
especially interesting,
because it is possible that
increasing levels of
supplementation may, in some
cases, be of benefit.
To understand what an
antioxidant is, we need to
learn a little more about
the way our bodies work.
I'll try to keep this
simple.
How Antioxidants Work
The body is made up of
molecules, combinations of
atoms constructed in a
particular way to do a
specific job.
The molecules that take part
in or regulate processes in
your body are held together
by the forces between their
electrons, which have a sort
of magnetic attraction to
one another, and fit
together based on that
attraction.
Many molecules within your
body exist periodically in
what is called an oxidized
state. This means that they
have one or more unpaired
electrons. They are looking
for molecular partners,
often at the expense of
other important molecular
relationships. When they are
in this state, they are
called free radicals.
These free radicals can
react much more with their
surroundings, often in ways
that are damaging. They can
interact with and disrupt
many finely tuned processes
which are needed to maintain
the body.
In some cases, the presence
of these active molecules,
or free radicals, can be
helpful. Cells of your
immune system, for example,
rely on the destructive
power of free radicals and
use them as ammunition,
discharging them where
infection is present in
order to kill the invaders.
But along with the
destruction of unwelcome
cells or organisms, there
can be damage to nearby
tissues and processes your
body needs.
In other cases, however,
free radicals are simply an
unavoidable by-product of
body processes -- the
leftovers, so to speak, of
necessary reactions -- and
serve no useful purpose. In
these cases they are like
static on the radio: they
mess things up a little, but
the music keeps on playing.
All of this is true for
every living body.
Our bodies contain natural
substances, called
antioxidants, which can
gather up and neutralize
free radicals, limiting
their capacity for
destruction. Often there are
not enough to do the whole
job.
There are stages or
circumstances in our lives
in which free radicals and
their damage are increased.
Much of the deterioration we
see in aging, for example,
results from the presence of
an increased amount of these
reactive molecules. Our
natural stores of
antioxidants cannot
successfully overcome the
increase. In states of
illness or infection, free
radical presence is also
increased and results in
many of our symptoms. This
is of special concern for
people with HIV, in whom the
normal antioxidant defense
system is compromised.
Alcohol and other substances
increase the number of free
radicals, and hence the
damage they do to the body.
We'll talk more about that
later, when we look at
alcohol and HIV.
What makes all this very
important is that, given the
chance, the HIV virus uses
free radicals to establish
itself. Free radicals
activate the critical step
in the actual copying of
genetic material needed to
reproduce the virus. And the
virus itself stimulates
their increased presence.
The more we can swamp them
with extra antioxidants, the
harder it is for HIV to
grow.
This has been proven, and is
currently the subject of
substantial research around
the world. We already know:
If you add antioxidants to a
culture dish in which HIV is
growing, activity of the
virus is profoundly reduced,
and HIV production is
inhibited.
If antioxidants are removed
from a culture dish in which
HIV is growing, production
of the virus is increased.
The amount of certain
natural antioxidants is
decreased in the blood of
people with HIV, and
antioxidant levels decrease
progressively with
increasing illness.
The results of some studies
suggest that antioxidant
supplementation may slow the
progression of HIV.
We can help our system to
protect and repair itself by
increasing its antioxidant
supply. This chapter will
look at some of the natural
antioxidants our body uses,
which we can easily increase
with supplementation.
There are also some
antioxidants not found
naturally in the body, which
are being studied for their
possible role in fighting
HIV.
Vitamin C (Ascorbic Acid)
Vitamin C is the best known,
the most studied, and the
most frequently supplemented
antioxidant. It is easily
absorbed in the small
intestine, as it is a simple
carbohydrate, and it is
excreted in the stool and
urine. The kidney reabsorbs
it from the urine when
supplies are low.
Absorption, both in the
kidney and the small
intestine, is reduced when
intake is greater than 200
milligrams per day.
The bulk of its impact on
wound healing is due to its
role in making collagen, the
building block of new tissue
formation. Thus it helps
maintain our very structure.
It also may offer special
protection to the lung, by
reducing damage to delicate
lung tissues caused by
activation of the cells of
the immune system.
Vitamin C is involved in the
manufacture of hormones,
steroids, and
neurotransmitters -- the
substances by which our
nerve cells speak to one
another. It is necessary for
the conversion of folate
into its active form. It
also assists in iron
absorption.
Our need for and utilization
of vitamin C increases in
the presence of infection or
injury. With inflammation
and fever we consume more.
Major burns increase
requirements by a
hundredfold. And if we are
malabsorbing, we must take
in a lot to get in a little.
Frank vitamin C deficiencies
are rare; they manifest as
poor wound healing, easy
bruising and bleeding, and
anemia.
Vitamin C has been studied
in the medical literature,
and it is touted in the lay
literature for its effects
on the common cold -- a
viral infection -- both for
prevention and recovery. One
study treated patients newly
infected with colds, using
either vitamin C (6 grams a
day for five days) or a
placebo. (A placebo is an
inactive substance made to
look like the pill being
studied, so that neither the
doctor nor the patient can
tell who gets the real
thing.) Improvement was so
striking in those receiving
vitamin C that it was not
possible to hide their
identity from the doctors
who observed them.
Other studies did not show a
reduction in the number of
colds contracted, but did
show that colds were shorter
and less severe with vitamin
C supplementation. And fewer
superimposed bacterial
infections -- which often
follow colds when resistance
is down -- have been
reported.
There has been considerable
interest, in the
HIV-positive community, in
the role of vitamin C
supplementation. So let's
look at the nature of
vitamin C. We know that,
except for guinea pigs,
humans are the only mammals
who can't make it. We know
that, pound for pound, the
average mammal makes the
equivalent of up to ten
grams a day for an organism
our size. We know that this
production is not static,
but increases when an animal
is stressed (for example, by
infection). Rats, when
stressed, have been shown to
increase their production
tenfold. We know that the
amount of supplementation
required to cause diarrhea,
a side effect of high
supplementation, increases
when we have an infection --
suggesting that we use more,
if we have it, when we need
it. Interestingly, levels of
vitamin C have been found to
be reduced in humans during
infection with the common
cold. We use more when we're
sick, and we can't make more
to replace it.
Part of the role of vitamin
C in infection is to react
with and neutralize free
radicals. Cells of the
immune system release toxic
substances to kill an
invading germ or virus;
surrounding tissues are also
damaged; and the free
radicals which result can
extend that damage further.
This is particularly
worrisome in people with
HIV, because the virus needs
just such an environment --
one with excess free
radicals, in an oxidized
state -- to reproduce
itself. And vitamin C is a
powerful antioxidant.
Vitamin C also helps
increase the net antioxidant
action of vitamin E. Some of
vitamin E's actions can
actually oppose its
antioxidant effect, but in
the presence of vitamin C
this does not happen.
Perhaps because of its
antioxidant properties,
vitamin C use is associated
with a reduced risk not only
of infection, but also of
heart disease, cataracts,
and some cancers. It helps
protect against the ravages
of cigarette smoke and city
smog. Preliminary data
suggest a role for vitamin C
in treating or helping
prevent heart attacks,
adult-onset diabetes, some
long-term side effects of
psychiatric drugs, and other
chronic disorders.
Some cells in the immune
system contain up to fifty
times as much vitamin C as
is found in the blood. This
may help protect these cells
against the kind of damage
they cause their
surroundings, from the
compounds they make to fight
infection.
While there can be problems
with oversupplementation of
vitamin C, most of them
occur only at very high
doses. Diarrhea is the most
common. It rarely occurs at
doses of less than 4 grams,
or 4,000 milligrams, a day,
and it resolves when amounts
are reduced. In fact, those
who take high doses of this
vitamin often choose their
dose by increasing their
intake daily until diarrhea
appears. And, as we have
said, that diarrhea is not
present at the same dose
during times when their
system is stressed. It's a
natural way to ask your body
how much vitamin C it can
handle.
There are people, some of
them doctors, who advocate
massive doses of vitamin C
-- up to 10 or more grams a
day. But such doses are not
without risk. Kidney stones
can precipitate at very high
intake levels.
At this point, until the
results are in, I recommend
an intermediate dose of 1 to
3 grams a day, as tolerated.
During periods of active
infection you can double or
triple this dose; but I
suggest no more, for now,
than 6 grams a day. For
those who are committed to
higher doses, consider
taking baking soda, to keep
your urine alkaline and to
reduce the risk of stones.
Drinking large quantities of
water can help prevent
kidney stones, too.
Remember that we have no
proof of what constitutes
the perfect dose. But you
and I just don't have time
to wait. To quote a 1994
editorial in the Journal of
the American College of
Nutrition: "Antioxidant
nutrients appear remarkably
benign, even at high
supplementary intakes....
[R]ecommendations to wait
until every conceivable
study has been designed and
conducted to achieve a level
of absolute certainty will
result in the continuing
cost of the disease to the
individual and to society"
(Hemila, 1992).
Basic multivitamin
preparations contain 60 to
180 milligrams of vitamin C.
You'll find some vitamin C
in your B stress, or
B-complex, vitamins. You
need not count this in your
total.
Vitamin E (Tocopherol)
Vitamin E is absorbed in and
with fat; it requires
pancreatic and biliary
enzymes for absorption. Its
antioxidant properties serve
to protect and stabilize
cell membranes. It is found
in vegetable oils, and to a
lesser degree in eggs, whole
grain cereals, and butter.
You can get a little from
vegetables. Frank deficiency
is rare and takes a long
time to occur, but can be
seen when there is lasting,
severe fat malabsorption. It
can also be seen after
long-term TPN
administration. Effects of
vitamin E deficiency include
peripheral neuropathy, poor
position sense and balance,
and a reduction in knee-jerk
and other reflexes.
Deficiency of this vitamin
alone in those who are not
HIV positive can result in
the same immune system
abnormalities found in
people with HIV infection.
Cell membranes have a fat,
or lipid, layer. Free
radicals in these membranes
react with oxygen and
initiate a chain reaction
forming new free radicals at
every step in the chain.
Vitamin E counters this
process by entering the
lipid membrane and uniting
with the free radical. The
molecule which results has a
different shape; it sticks
its head out of the
membrane, where it becomes
visible to vitamin C. When
attacked by vitamin C, it
can be reduced back to a
stable molecule, and the
chain of damage is halted.
It's important to know what
kind of vitamin E you're
taking. If its not alpha
tocopherol, which is
naturally produced, Vitamin
C won't recognize it, and
you won't get all of this
effect. If it's gamma
tocopherol, such as is found
in soybean oil, it will be
excreted quickly. So you
should try to find
supplements which contain
alpha tocopherols. These
have the most activity. Most
vitamin E is sold in the
alpha form.
Vitamin E is used in a
variety of circumstances for
its antioxidant effects. It
is under study in
combination with vitamin C
and beta-carotene, for
example, as supportive
treatment for those with
cholesterol disorders, along
with appropriate
cholesterol-lowering drugs.
Its supplementation has been
shown to increase
cell-mediated immunity in
healthy elderly people. This
is exactly the type of
immune response which is
impaired, and eventually
destroyed, by HIV disease.
In each of these studies,
the dosage used has been
eight hundred units a day.
Vitamin E is also one of the
vitamins which can be taken
in relatively large doses
without toxicity.
Dietary supplementation of
vitamin E is thought to
increase AZT's effectiveness
in fighting the virus. And,
in the presence of HIV
infection, vitamin E intake
may decrease the speed of
progression to AIDS.
We have already noted that,
in laboratory cultures of
HIV, addition of
antioxidants slows the rate
of growth of the virus. With
high enough doses of vitamin
E, growth may actually be
halted; those doses,
however, are so high that
they kill the cells in which
the virus has been cultured.
Thus, the toxicity of
vitamin E at super-high
doses limits the extent of
its effect. In moderately
high doses, however, it may
stimulate, and perhaps
protect, some of the immune
cells the virus is known to
destroy.
Low levels of vitamin E have
been found to correlate with
the presence of HIV and
other infections,
particularly in immigrants
from developing countries.
The Italian studies which
reported this finding did
not investigate which
abnormality-infection or
vitamin E deficiency-might
have come first. They did
report, however, that
vitamin E was found to be
deficient in study subjects
with AIDS, and in about a
third of intravenous drug
users who did not have
evidence of HIV infection.
This association of vitamin
E deficiency with migrants
from developing countries,
and with intravenous drug
users, was also reported in
another Italian study,
raising the possibility that
low levels of vitamin E and
other antioxidants might
actually play a role in
initial infection, as well
as in progression to AIDS in
those already infected.
In another study, blood
levels of vitamin E were
found to be low in 27
percent of HIV-positive
men-four to five times as
many as those who are
deficient in vitamin A or C.
Thus, we know that vitamin E
helps slow the growth of the
virus; we know that your
vitamin E level may be
deficient if you are
infected; and we know that
moderately high doses won't
hurt you. Given these facts,
it makes sense to supplement
vitamin E.
Based on recommendations for
other health conditions, I
recommend 800 to 1,200
milligrams of vitamin E a
day.
Your standard multivitamin
has only about 30 milligrams
of vitamin E. Centrum
contains none.
Vitamin A
Like vitamin E, vitamin A is
a fat-soluble vitamin. It
occurs in its active form in
milk products, meat, and
saltwater fish. Green leafy
vegetables, carrots and
other yellow root
vegetables, and yellow and
orange fruits contain
beta-carotene, which the
body can convert to vitamin
A. Depletion results from
malabsorption of fats, or
from the use of mineral oil
as a laxative. Alcohol use
can also contribute.
Beta-carotene conversion to
active vitamin A in the body
can be defective in people
with diabetes or
hypothyroidism. Long-term
TPN can promote deficiency,
too.
Dry eyes, night blindness,
and other eye conditions are
symptoms of vitamin A
deficiency. In extreme
cases, blindness can result.
Also, white cells can be
reduced, as can red blood
cells. Resistance to
infection is impaired. Thus
vitamin A deficiency can
result in more, and more
severe, diseases of many
types. Even a mild
deficiency has been shown to
increase the risk of
pneumonia, diarrhea, and
even death in children.
Supplementation with
beta-carotene, the
recommended form of vitamin
A replacement, has been
shown in one study to
increase the number of T4
lymphocytes in healthy,
HIV-negative people. This
kind of immune cell-the kind
you want to hold on to-is
entered, taken over, and
eventually destroyed by HIV.
One of the fourteen
participants in this study
reported diarrhea. No other
side effects were seen.
And what about the
particular need for
supplementation in people
with HIV? In a study of over
one hundred HIV-positive
patients with no symptoms
other than enlarged lymph
nodes, 18 percent were found
to be deficient in vitamin
A. Another study, also
showing lower levels of the
vitamin in HIV patients,
reported no effect on
T-cell, or CD4, counts.
So once again, we find that
higher levels of a vitamin
may help protect against
HIV's effects on the immune
system. We know that lower
levels are likely to be
found in the presence of
HIV, just when its support
is most needed. We know this
can happen early. We also
know, however, that an
excess of vitamin A is toxic
and must be avoided.
Too much vitamin A -- called
hypervitaminosis A -- can
result in high levels of
blood calcium, as calcium is
pulled from bone. Vomiting
and headache can result.
Bone and joint pain are
features also. In extreme
cases there can be liver
damage. A recent study
showed increased lung cancer
in smokers who supplemented
their vitamin A intake. This
is of less concern for you,
but it does point to the
fact that inappropriate use
of vitamin A, even as
beta-carotene, can actually
promote free radicals.
Hypervitaminosis A is one of
the more common types of
vitamin excess. You can
monitor yourself for it by
watching the color of your
palms, and by looking for
yellow coloration in the
places where you sweat. But
the best way is to monitor
your intake.
Doctors have a shared joke:
an alcoholic, they say, is a
person who drinks more than
her or his doctor. In my
office we define a patient
with hypervitaminosis A as
someone whose palms are
yellower than mine.
One of the ways we avoid
vitamin A toxicity is to
supplement in the form of
beta-carotene. I do not
recommend taking a direct
vitamin A supplement. Nor do
I recommend cod liver oil.
Even in the form of
beta-carotene you shouldn't
go overboard. I suggest 15
to 30 milligrams a day,
which will give you the
equivalent of twenty-five
thousand to fifty thousand
units of vitamin A. If you
drink carrot juice most
days, you can skip
supplementation entirely.
Hypervitaminosis A can even
be seen in people who take
no supplements, if they live
their life on carrot juice.
You'll find about 3
milligrams, or five thousand
units, of vitamin A in most
multivitamins. High-dose
preparations can have up to
three times this much.
Minerals
The regulation of mineral
balance in the body is
essential to survival. Like
the body itself, each cell
is a living organism and
must maintain its internal
environment. And it must
interact with its
surroundings in order to
perform the functions
assigned to it. The movement
of minerals across cell
membranes, between the
extracellular and
intracellular fluid, forms
the basis for the body's
most primary functions.
Electrical activity is
initiated; hearts beat,
nerve cells signal. Muscles
respond. Blood vessels
tighten or relax. Water
balance is maintained.
Here is a look at how some
of these processes work, and
a survey of the need to
supplement in the setting of
HIV.
Sodium and Potassium
These minerals, as they flow
back and forth across cell
membranes in controlled
fashion, maintain
homeostasis in the cell, and
in the organ and the body
that it is part of.
The body's ability to
regulate and maintain its
stores of sodium and
potassium is impressive.
Except in the case of severe
illness, or the use of
certain medications or
intravenous fluids, there
should be no special need to
supplement. In those cases,
your doctor will monitor
your levels.
Calcium and Phosphorus
While there is a recommended
dietary intake for calcium
and phosphorus, deficiencies
are rarely a problem.
Calcium will be found in
your multivitamins in
varying amounts; about 30 to
150 milligrams of phosphorus
will be present in your
daily vitamin, and it's
commonly present in foods.
If levels are low in the
blood, it will be because
you're sick, and your doctor
will be watching them.
If in fact you have lost a
lot of weight, have recently
been ill, or are now ill,
you might want to monitor
your phosphorus level. It's
found on a routine chemistry
panel.
Magnesium
Magnesium, however, is a
different matter. It plays
an active role in the
metabolism of sodium,
potassium, and calcium. It
acts on your heart and blood
vessels, your nerves and
muscles, and your gut. Most
of it is concentrated in
tissue, so levels in the
blood don't tell us much.
Kidneys spill magnesium.
Losses also occur in the
stool and through the skin.
Malabsorption can reduce its
availability from the diet.
High alcohol use reduces it.
Diuretics and some
antibiotics deplete it.
Levels are often low in
states of severe infection,
and often then rise in that
setting, suggesting that
tissue damage and cell death
cause its release. Then it's
carried out of the body and
lost. Thus illness can
deplete you rapidly; and
your doctor may not know it,
even if she or he tests you.
Calcium deficiency results
from magnesium depletion,
and may not respond to
treatment without magnesium
supplementation.
Unlike calcium, there are no
reserves in bone to draw on
if magnesium supplies get
low. But also unlike
calcium, you cannot get too
much.
Recent studies show that
magnesium supplementation
can reduce lung injury from
oxygen toxicity. It blocks
blood vessel constriction,
so it can augment blood
flow. It has been shown to
increase the speed of
recovery from open heart
surgery, and to improve the
likelihood of recovery from
severe, life-threatening
infection.
Since it can be hard to get
magnesium in and easy to
lose it, since it's so
important, since you can't
get too much, and since too
much can't hurt you, it
makes sense to supplement.
The only time you shouldn't
supplement your magnesium is
in the case of kidney
failure. If you can't
excrete it in the urine, it
can build up. Otherwise,
you're safe.
One hundred to 125
milligrams are found in most
multivitamins. Theragram M
has only 24 milligrams.
Trace element combinations
generally contain 100 to 500
milligrams. The RDA for
magnesium is 400 milligrams.
Given the exciting results
of all the new research
described above, you may
want to beef up your program
with a separate magnesium
supplement. There's no way
to know how much is enough.
For now I suggest 500 extra
milligrams a day, on top of
whatever's in your
combination pills.
Trace Elements
These are other elements
whose quantities are small
but whose contribution is
enormous and essential.
There are seven essential
trace elements described in
humans: chromium, copper,
cobalt, iodine, iron,
selenium, and zinc.
There is no known use for
cobalt except as part of
vitamin B12. No deficiency
of manganese has ever been
reported. Iodine is
important in thyroid
metabolism, but has no known
potential role in HIV in the
absence of thyroid disease.
It's present in small
amounts in combination
pills. Supplementing this
element aggressively may
meddle with your thyroid
levels, so I don't recommend
it.
The remaining trace elements
are discussed below.
Chromium
Chromium helps insulin
perform, so it's needed by
your cells to take up
glucose. Thus when it is
deficient, blood sugar
levels can be elevated.
Cholesterol and triglyceride
levels rise too. Peripheral
neuropathy has been
reported, as has weight
loss. Heavy exercise,
infection, and injury
increase its use, and hence
its loss.
Chromium is found in good
supply in brewer's yeast and
in meats and cheeses.
The normal American diet is
said to contain only about
half of what we should have,
but deficiencies have rarely
been reported. And the above
effects are the only ones
we've seen.
The RDA, which is all we
have to go by here, is fifty
to two hundred micrograms.
There are no studies
reported on its importance
in HIV.
Multivitamins contain from
15 to 100 micrograms of
chromium. Trace element
supplements can add another
100 micrograms or so.
Copper
Copper is a necessary part
of some of the enzymes which
help inactivate free
radicals. Thus it plays a
part in antioxidant
protection. It is also used
for making blood cells. It
is active in the metabolism
of iron. Copper-containing
enzymes are involved in
immune function.
Absorption can be reduced by
critical illness, by
high-dose zinc
supplementation, and by
antacids. Deficiencies are
rare. Measurement is
difficult. Excesses can be
harmful and can lead to
liver failure.
Copper supplementation is
not normally recommended,
except for those on TPN.
However, copper deficiencies
have been reported in people
with HIV, and it is further
reduced with AZT treatment.
One study, though, showed
higher levels of copper in
people with HIV.
There is no RDA for copper.
Two to 3 milligrams are
generally found in daily
multivitamins.
Iron
Iron is needed to make red
blood cells. It can function
as an antioxidant. Vitamin C
promotes its absorption.
When your body needs more
iron, it absorbs more from
your diet.
Deficiency leads to anemia.
Malabsorption can result as
well. When present in
excess, though, iron can
work against you. Iron is
frequently sequestered in
the body to prevent its use
by bacteria as a source of
fuel. Increasing iron
inappropriately might lead
to increased infection.
Iron attaches to proteins;
it is first stored and then
carried throughout the body
by these proteins. But in
states of chronic illness,
the supply of these proteins
is reduced. Storage capacity
is thus limited. And when
the body runs out of safe
places to put its iron,
what's left is deposited in
tissues. The function of
these tissues can be harmed
by this process,
particularly in the liver
and the heart.
When present in excess, iron
can actually stimulate free
radical formation.
Unless you're menstruating,
or otherwise losing blood
regularly, there's no way to
get rid of excess iron. And
while insufficient iron can
cause anemia, anemia may not
mean that you need iron.
In one study, higher levels
of iron were found in
HIV-positive subjects than
in HIV-negative subjects.
Low levels of iron should be
interpreted by your doctor
in the context of other
tests, before you supplement
your intake. These tests
show not only what your
level is, but also whether
you have a safe place to
park it.
Supplementation in
documented deficiency states
is prescribed at 325
milligrams, one to three
times a day.
You'll get about 18
milligrams in most vitamin
supplements, and the same in
trace and mineral
combinations. If your
multivitamin specifically
advertises iron, in its name
or loudly on its label, it
may contain more. I suggest
you stay with a regular
multivitamin.
Iron is found in red meats,
liver, beans, and peas. The
RDA ranges from 7 milligrams
a day to 14 for women who
menstruate.
Because of its potential for
harm when oversupplied, and
until we can better
interpret its role in people
with HIV, I recommend not
supplementing on your own
beyond what you get in
combinations.
Selenium
Selenium is an especially
important antioxidant for
you. It has been found to be
depleted in both the tissues
and the blood of people with
AIDS, suggesting a
deficiency of long standing.
Selenium deficiency has been
found in patients with or
without diarrhea and
malabsorption. Eighteen
percent of the men in one
HIV study, all asymptomatic,
were found to be selenium
deficient.
Levels go down as the
disease progresses. Selenium
levels correlate with
albumin levels, with lean
body mass, and with total
lymphocyte count-all markers
of immune function.
Supplementation has been
shown to improve symptoms
and blood levels, but not
these other markers. Further
studies of its use, in
combination with other
antioxidants, are underway.
Infection and increased
metabolic rates compound the
loss of selenium.
Selenium deficiency is
associated with heart
disease and with anemia.
Thrush is more common, and
CD4s drop. Some patients
report that their thrush
goes away when they start
selenium supplementation.
Current trials will tell us
more about the value of
selenium supplementation.
For now, I recommend it. The
10 to one 100 micrograms
you'll get in your daily
vitamin and trace element
supplements is a start. I
recommend an additional 50
micrograms from one to four
times a day.
I don't advise huge amounts.
Selenium functions with --
and very much like --
vitamin E. We know more
about vitamin E, and we know
it's safe to push the dose.
We don't yet know that about
selenium.
There is as yet no RDA for
selenium.
Zinc
Zinc can be shuttled from
blood to tissue in times of
stress or illness. Thus
plasma levels may not
reflect its true
concentration in the body.
Zinc is absorbed in the
small intestine. High-fiber
diets and the presence of
parasites can limit its
absorption. Only 25 percent
of what's ingested is
absorbed, at best; with poor
intestinal absorption, the
amount can be even less.
Wound healing and the
maintenance of membranes are
among its tasks. It also
plays a role in antibody
production, and other
aspects of immune response.
With zinc deficiency, immune
response is impaired. Hair
loss can result. Night
vision is lost. We may think
less clearly. Wound healing
is slowed, and protein
metabolism impaired.
Diarrhea can be both a cause
and a result of zinc
deficiency, and thus can
compound the problem. Zinc
should always be
supplemented in people with
severe, chronic diarrhea.
A reduction or change in our
sense of taste can also
result from zinc deficiency.
This can be especially
disturbing, as it affects
both appetite and
absorption.
Levels of testosterone, a
male hormone, drop in states
of zinc deficiency. This is
particularly interesting to
men with HIV, of which up to
20 percent are said to have
low testosterone levels. In
my own practice, I don't
tend to see that so
often-but I certainly see it
in 10 percent of my male
patients, and particularly
in those with advanced
illness. Loss of sexual
desire and a decreased
ability to lay down lean
body mass are associated.
Some, but not all, studies
have shown reduced zinc
levels in people with HIV.
Remember, though, that these
are blood levels. They may
not reflect tissue levels.
AZT lowers zinc levels.
Some investigators report
improvement of symptoms with
supplementation. When taken
in excess, though, zinc can
weaken immune system
function and lower calcium
levels.
I'm particularly concerned
about the results of a study
set up in 1984. Two hundred
eighty-eight HIV-positive
men were asked what
supplements they took, at
the time they entered the
study. They were then
monitored for seven years
for progression to AIDS.
High daily intakes of
vitamin C, biotin, and
niacin were associated with
slower progression to AIDS.
High zinc intakes, however,
were associated with faster
progression-in a pattern
consistent with the amount
of intake. The authors
concluded that high levels
of zinc supplementation may
have harmed immune status in
these men.
It's hard to rely too much
on this study, as other
factors may have been
involved. Still, it raises
concern about zinc.
So we know we need some
zinc, and we know we may
have less in the setting of
HIV infection. We also know
a little bit of it may help
reduce symptoms. And we know
too much may be bad for us.
Multivitamins usually
contain about 15 milligrams
of zinc. Trace element
supplements have 20 to 25
milligrams. Separate zinc
supplements usually contain
50 to 60 milligrams. You'll
get about 50 milligrams,
then, if you take two
multivitamins and a trace
element supplement each day.
I think that should be
enough.
The RDA for zinc is 15
milligrams.
What to Do
Now that you have all this
information, you have to
decide what to do with
it-just how aggressive, how
committed you want to be.
To start with, you see how
important it is to eat a
healthy, varied diet,
including the foods we've
mentioned, to help supply
these nutrients. Everyone
should do that.
It is worth mentioning that
even routine daily use of
one multivitamin pill has
been associated with a
longer delay in progression
from HIV to AIDS. We
recommend this to all our
patients.
The simplest schedule, then,
is as follows:
A multivitamin, without
extra iron, twice a day
A trace element supplement
once a day
An antioxidant supplement
once a day
While this may not offer you
all of the possible benefits
of the high-dose
supplementation described
below, it should help
prevent frank deficiencies.
And if it's hard for you to
eat or to get pills down, or
if money is a problem, this
will give you a safe,
supportive regimen that is
easy and inexpensive.
If you want to do more,
here's my recipe:
A multivitamin, without
extra iron, twice a day.
A trace element supplement
once a day.
A vitamin C supplement,
1,000 to 3,000 milligrams
(as tolerated), once a day;
or 3,000 to 6,000 milligrams
(as tolerated), once a day
during periods of active
illness.
A vitamin E supplement
(alpha tocopherol
preferred), 800 to 1200
units, once a day.
A beta-carotene supplement,
15 milligrams (with 25,000
units of vitamin A), twice a
day.
A vitamin B stress complex
supplement twice a day.
(These offer higher doses
than an average B-complex
supplement. They have a
little added vitamin C, to
promote their absorption.
You needn't count this
vitamin C toward your
recommended vitamin C
total.)
A magnesium supplement, 250
milligrams, twice a day.
A selenium supplement, 50
micrograms, one to four
times a day.
This is imprecise, because
these studies are in their
infancy. But it's a good
place to start. And it takes
into account the dangers of
oversupplementing.
If your own regimen
currently calls for more
than what I've outlined, or
calls for different
substances, be sure to
consider the dangers we've
looked at above. You don't
want too much of a good
thing.
It's a good idea to take
your vitamins with food, if
you can.
Here in the United States,
vitamins are easy to buy.
There are health food stores
in every town; even
supermarkets and drug stores
routinely carry a supply of
the basics. But in other
countries, where attention
to nutrition is less a part
of the popular culture,
they're harder to find.
I was surprised, in speaking
with AIDS activists and with
educators associated with
the French HIV information
service SIDA, to find that
access to vitamins was so
limited, and their cost so
high, in Europe.
If you can't obtain vitamins
where you live, a list of
sources for reasonably
priced, good vitamin
supplements is included in
Appendix IV. |
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