~HIV and AIDS, Part 4 - Nutritional Therapy

Nutritional Therapy

  • Vitamin C
  • Beta-Carotene
  • Vitamin B12
  • Lactoferrin
  • Coenzyme Q10
  • L-Glutamine
  • L-Carnitine
  • Olive Leaf Extract
  • SPV-30
  • Thymic Immune Factors
  • Silymarin
  • Enzymes
  • Plant Sterols

Thousands of research studies have demonstrated the positive effect that antioxidants have in managing immune suppression. The Life Extension Foundation was the first organization (in 1985) to propose that the decline in the immune function of persons with HIV may be prevented or slowed by taking high-potency antioxidant supplements. According to Marianna Baum, Ph.D., from the University of Miami Medical School: "Multiple nutritional abnormalities occur relatively early in the course of HIV infection and appear to facilitate disease progression" (Baum 1992).

Low levels of antioxidants and micronutrients in AIDS are most often related to low intake, as well as to malabsorption resulting from diarrhea, and also to metabolic problems and AIDS wasting. A high-potency multinutrient supplement, such as Life Extension Mix, that contains the nutrients most often deficient in those who are immune compromised is strongly recommended. An aggressive, comprehensive antioxidant "cocktail" that comprises high levels of nutrients will help prevent the progression of immune suppression due to oxidative cell damage. Some specific nutritional supplements will be discussed below.

Vitamin C. Vitamin C (ascorbic acid) is required for normal host defense and functions. An analysis of vitamin C uptake and its effects on virus production and cellular proliferation was performed. Exposure to high concentrations of vitamin C preferentially decreased the proliferation and survival of HIV-infected cells and caused decreased viral production. Studies showed high concentrations of vitamin C were preferentially toxic to HIV-infected host cell lines in vitro (Harakeh et al. 1991; Rivas et al. 1997). When plasma levels were measured for all antioxidant micronutrients in persons with HIV and in controls, it was observed that these patients showed a significant depletion of all carotenoids (lutein, lycopene, alpha-carotene, etc.) and vitamin C. Life Extension Mix contains water-soluble ascorbic acid, an ascorbate complex, fat-soluble ascorbyl palmitate, and a natural vitamin C juice powder, complete with synergistic bioflavonoids. It is considered the most comprehensive vitamin C complex ever developed in a nutrient product.

Beta-Carotene. Besides being very important to vitamin A production, the main function of the lipophilic antioxidant beta-carotene is to prevent damage to membrane and plasma polyunsaturated lipids. Immunostimulatory effects have been noted for HIV-infected persons using beta-carotene (Coodley et al. 1993).

The rapidly proliferating cells of the immune system are very rich in polyunsaturated lipids. In a study, people with AIDS were given 100,000 IU a day of beta-carotene (Fryburg et al. 1995). After 4 weeks of beta-carotene treatment, total lymphocyte counts rose by 66% and T-helper cells rose slightly. Six weeks after beta-carotene treatment, the immune-cell measurements returned to pretreatment levels.

Although this study demonstrated no toxicity associated with high-dose beta-carotene supplementation, the Life Extension Foundation does not recommend high-dose beta-carotene in AIDS patients who also have hepatitis. For some people who have hepatitis, the long-term use of beta-carotene may cause liver enzyme elevation, indicating potential liver damage. Many of those with AIDS are also infected with hepatitis B or C. People with AIDS who do not have hepatitis or other liver damage may consider consuming 25,000 IU of beta-carotene daily. Healthy people seeking to boost overall immune function should consider consuming 5000 IU of beta-carotene daily, along with other carotenoids, such as lycopene and lutein.

Vitamin B12. Vitamin B12 is essential to everyone for good health. Vitamin B12 is crucial to many enzymatic processes in the body and functions synergistically with folic acid and TMG to enhance DNA methylation and reduce toxic homocysteine in the blood. Vitamin B12, together with folic acid, is very effective at increasing the oxygen-carrying capacity of red blood cells. This is crucial for those taking most antiretroviral medications because these drugs are notorious for destroying the rapidly dividing red blood cells, causing severe anemia. Vitamin B12 has been used as a treatment for peripheral neuropathy caused by prescription medications by many people who have HIV. Severe neurological impairment can result in the elderly, as well, if vitamin B12 is deficient.

Vitamin B12 exerts a regulatory influence on T-cells, may increase appetite, and contributes to an overall sense of well-being. Studies have shown that patients with AIDS experience vitamin B12 deficiency as a result of a severe malabsorption syndrome (Remacha et al. 1991; Ehrenpreis et al. 1994; Rule et al. 1994). The most advanced form of this essential nutrient is methylcobalamin, which research has shown may function better than conventional forms. Sublingual vitamin B12 tablets are recommended at a dose of 500 mcg daily. If blood testing reveals a continuing vitamin B12 deficiency, weekly vitamin B12 injections may be indicated.

Lactoferrin. Lactoferrin is a subfraction of whey protein that has been found to both directly and indirectly inhibit several viruses that cause disease in humans. It directly inhibits viruses by binding to viral receptor sites, thus preventing the virus from infecting healthy cells. In vitro studies have found that lactoferrin strongly binds to the V3 loop of the gp120 receptor on HIV-1 and HIV-2, resulting in inhibition of virus-cell fusion and entry of the virus into cells (Swart et al. 1998). In addition, lactoferrin indirectly kills or inhibits viruses by augmenting the systemic immune response to a viral invasion. It is interesting to note that there is a systemic deficiency of lactoferrin in persons with HIV. One study that examined 22 asymptomatic and 45 symptomatic patients with HIV compared to 30 healthy controls found that "levels of plasma lactoferrin are decreased in HIV-1 infected patients in relation to the progression of the disease" (Defer et al. 1995). Another study found that the lack of lactoferrin (and secretory Iga) found in the oral cavities of people with HIV correlated strongly with the frequent infections in those areas often seen in patients with AIDS (Muller et al. 1992). Lactoferrin was also found to have "potent" antiviral effects against the replication of both human HIV and cytomegalovirus (CMV) in several in vitro studies with no cytopathic effects on healthy cells.

An adequate and cost effective dose of lactoferrin for the adjunctive treatment of disease is estimated to be 300 mg daily. There are dietary supplements that provide potent doses of lactoferrin extracted from whey. When using these supplements, it is important to use a form of lactoferrin called "apolactoferrin," which is depleted of iron. In studies, the apolactoferrin form has been shown to provide the benefits of lactoferrin as an antioxidant. Studies also show that the "apo" form may have additional benefits over that of other forms of lactoferrin.

Coenzyme Q10. Coenzyme Q10 (CoQ10) is an antioxidant produced in the body and found in small amounts in some foods. HIV-positive people are often deficient in this important substance. CoQ10 is found in high concentrations in the healthy heart, where it plays an important role in initiating cell-produced energy. Studies have documented its effectiveness in improving the quality of life in people with advanced heart disease, congestive heart failure, angina, and arrhythmia. It has been found to increase a number of immune parameters, including IgG, T4 cells, and the ratio of T4/T8 lymphocytes (Folkers et al. 1988; 1991; 1993). In a pilot study in AIDS patients, coenzyme Q10 supplementation provided significant benefits. It is suggested that HIV patients take at least 200 mg daily of coenzyme Q10 (Folkers et al. 1988; 1991; 1993; Yamashita et al. 1997).

L-Glutamine. There are causes of immune suppression that have been proven to create a malabsorption syndrome in the gastrointestional tract (e.g., diarrhea, metabolic conditions, AIDS wasting, and drug therapies) (see also the section on Other Causes of Immune Suppression). Malabsorption syndrome is a significant component in the vicious cycle of immune suppression because it can be considered to be both a cause and an effect of immune suppression. Therefore not being able to utilize ingested foods and nutrients can be a specific cause of malnutrition in immune-suppressed patients. It is essential to break the cycle of malabsorption, antioxidant depletion, oxidative stress, immunosuppression, and the resulting increase in malabsorption. It is helpful to remember that the majority of immune system components and their activity is located in the gastrointestinal tract. Immune system activity has a particularly dominant influence in the mucosal lining since the mucosal lining is the area of the body that must assimilate material entering the gastrointestinal tract from the environment.

In addition to its important role in the mediation of oxidative stress and free-radical damage, the amino acid glutamine also plays a major role in the overall health and well-being of the gastrointestinal tract and its supportive organs (stomach, small and large intestine, liver, pancreas, and gall bladder). Glutamine is vital to the function of intestinal cells called enterocytes. Enterocytes are located in the fingerlike projections of the mucosal villi. These cells make up the mucosal lining of the small intestines and are some of the most rapidly dividing cells in the body. They have high energy requirements. Glutamine is the primary nutrient for enterocytes. Enterocyte cells break down glutamine to form glutamate, which is then converted to ATP and used as the energy supply for the cells. Studies have confirmed that glucose (sugar) is not utilized as a fuel source for the intestine (Newsholme et al. 1985; Souba et al. 1985; Hartmann et al. 1989; Alverdy 1990).


  • Glutamine supplementation is clearly not indicated for individuals who have severe cirrhosis of the liver, Reye's syndrome, or any other metabolic disorder that can lead to an accumulation of ammonia in the blood because of an increased risk for encephalopathy or coma. Under these conditions, the body is unable to metabolize excess nitrogen, which converts to ammonia and can cause brain swelling and brain death. When the liver is severely damaged or when hepatic coma is imminent, glutamine is not effective and can actually cause further brain damage.
  • Wasting is a life-threatening condition that should not be self-treated. If you have involuntarily lost more than 10% of your body weight, you should suspect that wasting is taking place and seek the care from a knowledgeable physician. Bio Impedance Analysis can determine lean body mass and establish a baseline for you, against which the efficacy of future treatments can be judged. In addition to glutamine, it is also important to review the information about whey protein isolate, which is extremely bioavailable and tissue-sparing. In addition to these treatment recommendations, your physician may wish to include anabolic steroids, such as testosterone, and nandrolone, and growth hormone. Treatments with steroids and growth hormone are very well-grounded and medically prudent in some cases of wasting and should be considered when necessary.

A study in Nutrition (Shabert et al. 1999) reported supplementation of both antioxidants and glutamine in 28 patients with at least a 5% weight loss from baseline. The supplementation was found to increase body weight and cell mass and to normalize intracellular water distribution, while providing "a highly cost-effective therapy for the rehabilitation of HIV-positive patients with weight loss."

L-Carnitine. Another nutrient often overlooked by persons with HIV is L-carnitine. L-carnitine has been shown to boost immune function, via several different mechanisms, in order to protect the heart against AZT toxicity and to enhance essential fatty-acid and glucose uptake. Protease inhibitors (PIs) can raise triglyceride to harmful levels. L-carnitine can be an appropriate treatment for this side effect. High doses of L-carnitine have also enhanced immunological and metabolic functions in those who were deficient in L-carnitine. L-carnitine also has positive effects on preserving CD4 cells by affecting apoptosis (programmed cell death) (De Simone et al. 1993; 1994; Cifone et al. 1997; Di Marzio et al. 1997; Mutomba et al. 2000). The recommended dose is 3-4 grams twice daily on an empty stomach.

Olive Leaf Extract. Olive leaf extract is a nonprescription, over-the-counter food supplement that has been used as a natural treatment of viral, bacterial, fungal, and parasitic infections; skin diseases; arthritis; heart disease; and many other illnesses. The ethnopharmacology of the olive tree has a colorful historical past because it has been thought to be the tree that is referred to as the "Tree of Life" in the Book of Genesis. The ancient Egyptians may have been the first to employ the olive leaf as part of the mummification of their royalty. Hippocrates, the father of medicine, used olive oil to treat ulcers, cholera, and muscle pains more than 2500 years ago. In later cultures, olive oil was used as a popular folk remedy for the treatment of fevers. In the 1850s, the first formal medical documentation of the use of olive leaves to treat severe cases of fever and malaria was made. In 1854, a healing remedy of olive leaves was published in Pharmaceutical Journal, England's leading medical journal of that time. Italian researchers also discovered that olive leaf extract could lower blood pressure in animals. It was also confirmed that olive leaf extract increased blood flow to the coronary arteries, relieved arrhythmias, and treated intestinal muscle spasms. In addition, olive leaf extract is thought to have powerful antioxidant properties. Countless studies illustrate that antioxidant activity is crucial to the management of HIV disease.

Olive leaf extract contains a phenolic glucoside, known as oleuropein, which has been shown to be the source of its extremely powerful disease-resistant properties (Renis 1970; Hirschman 1972; Fredrickson 1994; Privitera 1996; Ripka et al. 1996; Gay Men's Health Crisis 1997-1998; Walker 1997). In the late 1960s, olive leaf extract was tested by Upjohn Pharmaceuticals and was found to kill a large number of viruses. According to Jim Van Sweden at Upjohn Pharmaceuticals, Dr. H. E. Renis conducted prolific research on olive leaf extract, working in Upjohn's Department of Virology. His study, "In Vitro Antiviral Activity of Calcium Elenolate," published in the peer-reviewed journal Antimicrobial Agents and Chemotherapy, revealed calcium elenolate's formidable antiviral activity because it inactivated almost all viruses tested against it (Renis 1970).

Calcium elenolate is a chemical compound of oleuropein found in olive leaves. William Fredrickson, Ph.D. (researcher and CEO of F+S BioGenesis Group, Inc.), has also studied olive leaf extract extensively and believes the compound (+)-2-epienolic acid found in olive leaf extract is a natural reverse transcriptase inhibitor. He cites Hirschman's (1972) study, "Inactivation of DNA Polymerases of Murine Leukemia Viruses by Calcium Elenolate," as documentation of olive leaf extract's reverse transcriptase mechanism of action. He also believes that it is a natural protease inhibitor because he has seen 100% protease inhibition activity in vitro while conducting a laboratory screen of oleuropein. However, there is no documentation to support his observation. In 1996, as an alternative to taking toxic pharmaceutical protease inhibitors, the AIDS community discovered this possible natural source of protease inhibitors known as olive leaf extract. It has been shown to be nontoxic in all animal studies, even when given in doses of 3 grams per kilogram of body weight. By functioning as a reverse transcriptase inhibitor and a believed protease inhibitor, it is selectively cytotoxic to virus-infected cells but has never shown any toxicity to human DNA alpha-, beta-, or gamma-polymerases.

Olive leaf extract has been taken by persons with AIDS in doses of one 500-mg capsule or tablet 4 times a day. Olive leaf extract products should have the recommended 23% oleuropein content and be guaranteed fresh.

Olive leaf extract does not have any side effects per se, although some people may experience a "die-off " effect (also called the Herxheimer reaction). A "die-off " effect is caused by a rapid increase in volume of waste material and pathogens being brought into the lymph system. Reactions to the die-off effect include extreme fatigue, diarrhea, headaches, muscle and joint achiness, and flu-like symptoms. These reactions are temporary and will pass once the body has expelled the circulating toxins. If these detoxifying symptoms are too uncomfortable, reduce the amount of olive leaf extract taken or discontinue using it temporarily. Upon feeling better, resume the supplement at a lower amount and increase it to your desired dose slowly. Testimonials about olive leaf extract may be obtained from Mark Konlee, Director of Keep Hope Alive, P.O. Box 27041, West Allis, WI 53227, (262)548-4344, or at www.khope@execpc.com.

SPV-30. SPV-30 is an herbal extract derived from the European boxwood tree (Buxus sempervirens), a species of evergreen (Durant et al. 1998). The proprietary extract is manufactured by Arkopharma in Nice, France. Arkopharma is the largest phytopharmaceutical company in Europe and is dedicated to natural herbal products. Research scientists have identified 20 active alkaloids in SPV-30 of a total of nearly 100, using HPLC (high performance liquid chromatography) and gas chromatography. The five most active alkaloids are buxtaurine, cyclobuxine D, boxamine, cyclovirobuxine D, and cyclovirobuxine C.

The potential of SPV-30 as a natural antiretroviral was first identified by Jacques Durant, M.D., head of the Infectious Diseases Department of the Hospital de l'Archet in Nice. He learned about SPV-30 from a person with AIDS who took SPV-30 and was able to maintain high CD4 levels over a sustained period of time despite episodic IV drug abuse and bouts of opportuniistic infections (OI).

In a double-blind, placebo-controlled Phase I trial in France, patients taking SPV-30 had an average increase of 94 CD4 cells after 30 weeks (Durant et al. 1998). The placebo group saw an average loss of 43 CD4 cells after 30 weeks. No toxicities were noted and no serious side effects were reported. These results encouraged Professor Luc Montagnier, codiscoverer of HIV and one of the world's leading AIDS researchers, to act as scientific adviser and chief virologist for an 18-month, multicenter, Phase II/Phase III study in France (Vandermander et al. 1996). The French Ministry of Health had classified the study as an antiretroviral trial. Of the 22 trials listed in the Ministry of Health 1995 Clinical Trials Directory, SPV-30 is the only natural herbal product listed in an antiretroviral trial.

As early as 1996, an informal, community-based study was conduced in the United States using SPV-30 in 400 HIV-infected subjects who had CD4 cell counts of 0-700 per microliter and plasma HIV RNA levels of 0-106 copies per milliliter. Although there was only mild plasma HIV-RNA activity, and the results were considered inconclusive, Bryson (1996) presented a preliminary analysis of this study to an AIDS conference in Vancouver, Canada.

Later evidence suggested that SPV-30 works primarily as an antiretroviral, as well as an antioxidant, which favorably alters overexpressed cellular transcription factors (Durant et al. 1998). SPV-30 inhibits HIV by targeting the reverse transcriptase enzyme, the same enzyme that AZT and other nucleoside agents target. There is evidence that SPV-30 reduces a cellular messenger, TNF-alpha, which becomes elevated in people with HIV. Many studies have shown that this elevation, associated with an inflammatory response, correlates with increased viral replication and cell loss.

One outcome of a number of SPV-30 studies was a noticeable quality-of-life improvement, experienced by many of the participants. When asked to comment on many factors affecting them, such as energy levels, ability to fall asleep, appetite, digestion, and overall sense of well-being, nearly half of the participants reported "much improved" energy, while other participants believed their energy levels were either much improved or about the same. About half also commented that their overall sense of well-being had greatly improved. These findings are significant enough to warrant consideration by those infected with HIV because so many of the taken-for-granted components related to quality of life begin to slowly erode after HIV diagnosis.

AIDS buyers' clubs around the country have anecdotally reported on a specific SPV-30 treatment regimen that has produced the most beneficial results. It is included here:

  • Upon rising, on an empty stomach, take five 500-mg capsules of bitter melon with 2 large glasses of water. Wait 30 minutes before eating.
  • Consume the following 3 times daily, with or without food, and with one large glass of water:
    • Glycyrrhizinate Forte (licorice), 300 mg, Jarrow Formulas
      Note: Licorice can elevate blood pressure.
    • 1-SPV-30 (boxwood extract), 330 mg, Arkopharma

  • Consume the following at the end of the evening, 2 hours after eating:
    • Bitter melon, five 500-mg capsules with 1 large glass of water

Thymic Immune Factors. Thymic Immune Factors is a synergistic formula that contains herbal activators and a full complement of homeopathic nutrients, in addition to fresh, healthy thymus, lymph, and spleen tissues, which produce white blood cells to fight invading organisms and cancer cells. The immunological tissue extracts in this product are raw, concentrated, toxin-free, and freeze-dried to preserve their biological activity. HIV-infected individuals may consider using a unique product such as Thymic Immune Factors to potentiate white blood cell production and activity.

Silymarin. Milk thistle extract, or silymarin, is a unique type of bioflavonoid that exerts a protective effect on the liver. This is of importance to persons with HIV, because they may be taking hepatotoxic antiviral medications and also because silymarin supports activities of the liver, one being the production of glutathione, which is extremely crucial in correcting immune system functioning. Silbinin is the most active constituent of silymarin, now available in the United States. Please refer to the section on Boosting Glutathione Levels for more information concerning products that promote healthy liver function (Flora et al. 1998).

Enzymes. Proper digestion of nutrients is necessary for maintaining good health in all of us. Persons with HIV or AIDS have an elevated necessity for life-sustaining nutrients. In many cases, even the consumption of all the correct nutrients simply does not result in adequate nourishment because of malabsorption. A comprehensive digestive enzymes formula should be used to encourage the greatest possible digestive activity. Some digestive enzymes are also used by the body to dissolve tumors, which can also be a consideration for those who are immunocompromised.

Plant Sterols. Beta-sitosterol and beta-sitosterol glucoside are substances found in plants, which are absorbed in human tissues after ingestion. Plant sterols have been found to have immune modulating activity and antitumor activity in animal models and human clinical trials (Bouic et al. 1999). These substances may also be obtained as supplements. Beta-sitosterol, taken in sufficient doses, has some antitestosterone activity. This antitestosterone activity should be taken into consideration by males using this therapy if decreased libido or decreased sexual function appears. Testosterone levels should also be monitored, which is usually advisable in ongoing monitoring of persons with AIDS.

Continued . . .
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