[pronut-hiv] Intake level for vitamin/mineral supplements for people with HIV infection

["Rachel Stern" <sternworks@verizon.net>]

Hi George. I agree with you that it's disappointing - shameful, even - that there is still no good, intelligent consensus on vitamin/mineral supplements for people with HIV infection. Dr Kaiser at least has made a stab at it.

However, I must agree with Vivica that the B6 recommendation of Dr. Kaiser 
is over the top by a magnitude of about 10. There are other problems with 
the Kaiser recs, as well. For example, the vitamin A could be problematic 
for pregnant women; the hefty iron (which you advise against) might be a 
good idea in some regions where iron deficiency is a problem, but not in 
others. The vitamin C is unnecessarily high (good research shows that, in 
healthy people anyways, tissue levels become saturated at far lower intakes (can't remember the exact figure, I think it's about 400 mg but I have to check). Selenium recommendations must certainly consider the geographic region.

Dr. Kaiser's protocol includes some very costly supplements whose merit has not been proven - alpha lipoic acid, for example. When resources are tight, there must be a good rationale for providing these. If you check Kaiser's website, at least this was true a couple of years ago when I last checked, the supplement regimen he recommends and sells is very costly and beyond the reach of most people (I'm talking about in the US now).

Taking a nutrient supplement regimen with this quantity of ingredients is, 
in itself, a big project just to get it all down. And is it all necessary? 
Glutamic acid? (MSG) That is a wierd ingredient I've never before seen in a supplement. At least it is too small an amount to matter.

Basically I feel there are 2 schools of thought on nutrient supplementation: 
One looks at the increased metabolic needs caused by chronic infection, the nutrient losses through malabsorption, etc and even the unproven hope that a nutrient(s) will directly fight HIV. The resulting recommendations are way above standard guidelines for healthy people.

The other way of thinking looks at the stress of chronic infection placed on the body's detoxifying mechanisms - the systems in the liver mainly, but elsewhere as well, that handle excess vitamins, drugs, and other foreign substances - and worry that too much nutrients put even more stress; and that, although HIV may increase nutrient needs above the RDA, HIV may also lower the limit of safety. For example, 4 or 5000 mg of vitamin C could cause diarrhea in some healthy people, but for a person already suffering from marginal intestinal function, less vitamin C could cause diarrhea. 
Recommendations based on this thinking would be closer to the RDAs.

Perhaps for many nutrients, there is a narrower range of what is optimal - 
more than the RDA, but less than what is ordinarily considered upper safety levels. That needs to be determined for each nutrient, and adjusted to each geographical region, obviously. That's how I feel, anyway, and I agree with the recommendation for "supplemental daily  MVI  at reasonable doses, in addition to a nutrient-dense and diverse diet adequate in calories, protein and micronutrients...."

George, I understand that you were providing the Kaiser recommendations as a jumping-off point for discussion, which is great. I'm just adding my 2 
cents.  Rachel