RE: [pronut-hiv] HIV and Multivitamin Supplementation

["R.Kennedy" <rkennedy@medunsa.ac.za>]

USE OF "POTENT MULTIVITAMIN" FOR PLWHA
Roy Kennedy


Dear George

I agree with most of what you have written, however your point on the
"potent multivitamin" raises come concern.

The preparation you suggest comprises very high doses of a number of
vitamins and minerals, way above the currently acceptable recommendations
built on the lack of information on sound reasons for specific amounts of
micronutrients, even though it is known that deficiencies are common.

The current recommendation do not exceed 200% of the RDA for each nutrient
in the old terms. The newer DRI raise the issue of safe upper limits of
intakes, but is not geared to people living with HIV/AIDS.

If is not prudent to advocate for your suggested high intakes at this stage
of the game.

Yours

Roy D Kennedy RD(SA)
Lecturer: Therapeutic Nutrition
Department of Human Nutrition
Medical University of South Africa
P O Box 177
MEDUNSA 0204
Republic of South Africa
rkennedy@medunsa.ac.za 




Some important points have been raised
George M. Carter
-------------------

First, what the ENA and RCQHC programs are doing is yet unclear to me. Is
there a website? I know I read an original post but have not reviewed it.

Second, I think developing some Guidelines and Recommendations is a first
step. These should consist of:
1. Access to cool, clean water.
2. Access to sufficient and varied food.
3. Distribution of a potent multivitamin (see below for a sample of what a
formula might look like). This will address deficiencies that have been
commonly observed and for which clinical data have supported this
inexpensive indication: particularly with regard to selenium, vitamin B12,
magnesium, vitamins A, E. Given the complex physiological interdependence of
these nutrients with other nutrients, along with the relatively low cost,
tolerability, safety and efficacy, it seems a no-brainer that should have
been implemented years ago.

Third--implementation is key. There are many stakeholders who can
facilitate that. First, the wealthier western nations could help fund some
of these efforts. Second, Debt Relief could be another source of funding,
tying forgiveness on the usury...er...interest of the failed SAP programs
of the World Bank could be a source. Third, local governments must be
assessed as to their ability and willingness to develop such programs.
Country by country, focusing on where things are worst. Of course, some
debt relief proposal might enhance the "willingness" aspect if they're
essentially transferring a debt payment to local projects and programs.
Fourth, identifying some of the better NGOs to help administer the programs
and providing infrastructure and development support would be a good tool.

Finally, such programs already have historical precedents, such as the OMNI
program and its sister Canadian organization that are micronutrient
initiatives focused on distribution of iron and iodine. The successes and
failures of these programs should be reviewed so that their good points can
be adopted and the problems avoided. Has any analysis of these programs been
undertaken? How much have the above programs dealt with those issues?
Another model to draw upon for distribution is the AIDS Drug Assistance
Program (ADAP) in the United States.

Don't forget that multivitamins are also made in Africa. For example, I
believe Lederle in South Africa makes a multi.

Other thoughts? Ideas?
George M. Carter

****
Potent multi:  NOTE that an IRON-FREE formula would be best. Iron given
only as needed separately.
Vitamin A (as retinyl palmitate)        5,000 IU
Beta carotene           20,000 IU
Vitamin C  (calcium ascorbate)  1,000 mg
Vitamin D                       400 IU
Vitamin E                       400 IU
Vitamin K (phylloquinone)       40 mcg
B1/thiamine (thiamine mononitrate)      50 mg
B2/riboflavin   50 mg
B3/Niacin       100 mg
B6/pyridoxine hydrochloride     50 mg
Folic acid      800 mcg
B12/cyanocobalamin      1,000 mcg
B5 (as calcium pantothenate)    100 mg
Biotin          300 mcg
Choline 300 mg
Inositol        100 mg
Calcium (as calcium citrate)    540 mg
Magnesium (as magnesium oxide)  253 mg
Potassium chloride      99 mg
Zinc (as monomethionate)        15 mg
Iodine (as potassium iodide)    235 mcg
Copper (as copper gluconate)    1 mg
Manganese (as manganese gluconate)       10 mg
Molybdenum (as sodium molybdate)        10 mg
Boron (as citrate)      1 mg
Selenium        300 mcg
Chromium (as chromium picolinate)       120 mcg
Cysteine (NAC)  1,800 mg
Alpha lipoic acid       300 mg
----------------------------------------------------------------------------
---

Elvira  wrote:
>
>Thanks for this interesting discussion. I started it so here is my reply
>to keep it going. The ENA concept proved useful to operationalize
>community-based programs at scale in child survival in several countries.
>The underlying premise is that if a limited focused number of proven
>interventions are operationalized, children's nutrition status can improve.
>
>Would a similarly focused approach impact the nutritional status of PLWHA?
>Well, the content of the ENA for PLWHA may differ because it needs to be
>responsive to their nutritional needs and evidence-based. Programmatically
>I would dare say that it can work.
>
>I would like to invite the members of Pronut-hiv  to look at the ENA
>BASICS II or RCQHC/LINKAGES developed and consider the programmatic
>aspects of operationalizing nutrition interventions at scale. What can be
>learned and effectively applied to reach PLWHA at scale?
>
>About content, I am not a nutritionist so I defer and agree with George
>about iron for mothers and vitmin B. I like Robert's proposal of
>sanitation and safe food handling. How can we make all this work at scale?
>
>Thanks, Robert and George for taking the time to reply. I really
>appreciate it. Elvira
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