Commercial production of vitamin C for fortification and dietary supplements

In most mammals, vitamin C is made in the liver from blood sugar using a four-step enzymatic process. Humans and about 20 other mammalian species lack one of these enzymes, requiring us to both obtain vitamin C from our diet and to sustain internal levels of vitamin C using a variety of other food antioxidants.

But rather than extracting vitamin C from foods, the modern way to manufacture it is to start with dextrose, a sugar identical to blood glucose, and manipulate it into ascorbic acid, which is vitamin C; mimicking the biological production technique to some extent. The result is a nature-identical vitamin indistinguishable from the form in foods.

The primary method of biosynthesizing vitamin C starts with the conversion of glucose into sorbitol. Dextrose is converted to sorbitol by adding hydrogen to the molecule; that is typically done with a catalyst (defined as an easily recoverable material that facilitates a chemical reaction but is not used up in the reaction nor added to the molecule). The only added element is hydrogen, which is applied in a pressure tank.

Converting the sorbitol into sorbose and then into an intermediate known as 2-KLG is done using a two-step fermentation process

Then a final lactonization step (reacting 2-KLG with acid and/or dehydration is used to produce the lactone known as l-ascorbic acid/vitamin C; chemical form C₆H₈O₆).

Do bioflavonoids enhance Vitamin C absorption?

Vitamin C absorption from the gut is governed by sodium content for active transport. For passive absorption throughout the length of the intestine the vitamin does not use a similar co-factor.

The bioflavonoids come into play after vitamin C has been absorbed and is in circulation.  This vitamin has a relatively short half-life and depends on other antioxidants to act as electron donors to 'reduce' oxidized vitamin C (dehydroascorbate) back into the antioxidant form (ascorbate; ascorbic acid).  Various antioxidants, including bioflavonoids and polyphenols in fruits, are typically used to provide that extra benefit.  So the recycling and longevity of vitamin C after absorption depends greatly on the presence of other antioxidants; including not only rutin and bioflavonoids but also alpha lipoic acid, glutathione, and numerous other antioxidants.

So there is a benefit to using a base, often called vitamin C complex, in a vitamin C formula, but not so much in the initial absorption as in the vitamin's retention and recycling for re-use over time.  The variety of antioxidant-related nutrients in the human diet is thought responsible for why humans can retain vitamin C between meals when we cannot manufacture our own from blood sugar at will, as most mammals can.

Natural versus Synthetic: Not Always Relevant

Synthetic processes are often irrelevant; the resulting form is the most important consideration. For example, most mammals synthesize ascorbic acid in their livers from blood sugar, so synthetic processes are essential in biological ascorbic acid production and all of their internally produced vitamin C is quite literally synthetically derived. This process is mimicked in commercial production.

This means that synthetic is not a synonym for unnatural; it depends on the process and the end result. If the compound is a synthetic form, such as dl-ascorbic acid, that is not so good. But if it results in a natural form, such as l-carnitine rather than d-carnitine, and mimics the synthesis of that substance in the body, our biology can’t distinguish between the internally and externally produced sources.

"Synthetic" loses its automatically negative connotation when considered in conjunction with these factors because we internally synthesize thousands of compounds every day and only the unnatural forms are presumed to be inherently negative when ingested.

Most vitamin studies are flawed by poor methodology

In a new published analysis, researchers at the Linus Pauling Institute of Oregon State University report that many large clinical trials of vitamin supplements, especially antioxidants like vitamin C, have flawed methodologies that make them 'useless' in determining the real value of such nutrients.

It is on the basis of such flawed studies created by researchers that are uninformed as to the nature of nutrients that their studies may conclude that vitamins are of no value or may even be harmful.

Of course, common sense tells us that essential nutrients cannot be inherently useless or harmful in reasonable doses, but those are messages that we repeatedly hear in the media reports.  Such flawed science leads to the equally flawed calls for vitamins to be regulated as drugs, adding a new logical error in failing to consider the vast difference in safety between nutrients and drugs.

Drugs are typically synthetic, isolated substances that are foreign to the body and don't act like nutrients, and it is this foreignness of drug properties that make them inherently toxic to the body. That toxicity is the legal basis of regulating drugs as controlled substances, and the failure to demonstrate toxicity of nutrients, except in studies with such flawed methodogies as we are discussing, makes calls to regulate vitamins as drugs hollow and illogical.

A report on that article:
http://www.nutraingredients.com/Research/Most-vitamin-studies-are-flawed-by-poor-methodology-say-Linus-Pauling-researchers

The original peer-reviewed publication in a peer-reviewed nutrition journal:
http://www.mdpi.com/2072-6643/5/12/5161

Functional Doses of Vitamins and Minerals for Bones

• Protein: 0.8 grams per kilogram of body weight

• Calcium: Over 1 gram per day

• Magnesium: 310 – 420 mg per day

• Zinc: 15 mg per day

• Copper: 2.5 to 3 mg per day

• Boron: 3 mg per day

• Manganese: 5 mg per day

• Potassium: 3,500 to 4,000 mg per day

• Vitamin D: over 500 IU daily

• Vitamin K: Levels are not well understood; at least 90 mcg/d for women and 120 mcg/d for men

• Vitamin C: over 500 mg daily

• Vitamin A: 2333 IU in women and 3000 IU in men; avoid low and excessive amounts

Palacios C. The role of nutrients in bone health, from A to Z. Crit Rev Food Sci Nutr. 2006;46(8):621-8. Review. PubMed PMID: 17092827.

Glutamine, MSG & excitotoxins, and protective nutrients

Clinicians giving several grams a day of pure L-Glutamine do not report excitotoxic reactions. The main one is for the synthetic chemical MSG. Sometimes people react to fermented foods, which indicates a problem in containment and nutritional status. Vitamin C removes glutamate from the neurons, which are additionally protected by antioxidants (tocotrienols, tocopherols, et al) and by magnesium. Branched-chain amino acids help to compartmentalize glutamates. Glutamine is fine with other aminos; the main competition is between the arginine pathway aminos (arginine, ornithine, and lysine); with another noted competition to get through the Blood Brain Barrier between the Large Neutral Amino Acids: aromatic aminos (tyrosine, phenylalanine, and tryptophan) and the BCAAs (leucine, isoleucine, and valine).

How are vitamins C, D and K in supplements made?

Almost all D’s on the market are nature-identical synthesized forms. D3 and D2 are both naturally occurring in foods, but in supplements the same forms are usually from synthesized sources. So D3 synthesized from sheep lanolin is no more natural than D2 from plants or fungi. In fact, the D3 made in the skin-liver-kidneys from cholesterol and sunlight is also literally synthesized. Either plant sterols or animal sterols (cholesterol in humans, lanolin from sheep) are irradiated with UV-B light to make D2 or D3, respectively. It is a synthetic process, either internally or to produce the supplemental form; in much the same way that vitamin C can be synthesized by most mammals (not humans) from blood glucose in a process that mirrors the commercially synthesized nature-identical form. By the way, Vitamin K is also synthesized as the exact same form found in green foods (K1). Fermented foods like cheese can also contain K2 (MK-4), which is synthesized by microbes like bacteria.

Unbalanced Fox news report misleads about vitamin-mineral safety

Unbalanced Fox news report misleads about vitamin-mineral safety By Neil E. Levin, CCN, DANLA I watched the special health report on vitamins and minerals on FOX-32 (How Do Vitamins and Minerals Really Affect Your Body? on 2/12/08, see link below), but was disappointed that the report exaggerated the risks of vitamins and minerals and minimized their benefits without any mention of the common deficiencies that exist in the American population. For example, the report cautioned about vitamin E causing blood thinning, but the Food and Nutrition Board of the Institute of Medicine has set an upper tolerable intake level (UL) for vitamin E (alpha-tocopherol) at 1,500 IU per day, which “is the highest dose unlikely to result in bleeding problems;” though the Institute has also said that the danger of the vitamin inhibiting clotting was not convincing. In other words, taking about four times the most common strength of even a hi-potency vitamin E capsule might be a problem in terms of affecting clotting, but this potency is higher than is available as a dietary supplement and one that people are unlikely to try without specific medical advice. Yet, somehow, the far more common danger of a vitamin E deficiency was completely ignored. This, despite the fact that, according to dietary data from the National Health and Nutrition Examination Surveys, ninety percent or more of the adults studied had usual intakes below the current Estimated Average Requirement. Why is a theoretical overdose problem even mentioned in the report, especially with no balancing mention of known deficiencies and benefits? What happened to fair and balanced reporting? And what are the benefits of vitamin E supplementation? An NIH-supported USDA -Tufts University study published in the medical journal JAMA reported, “…we observed a protective effect of vitamin E supplementation on upper respiratory tract infections, particularly the common cold,” for nursing home patients taking 200 IU of vitamin E daily. And Annals of the New York Academy of Sciences reported that, “The results of this clinical trial show that vitamin E supplementation significantly reduces the incidence rate of common colds and the number of subjects who acquire a cold among elderly nursing home residents.” Zinc was also mentioned in the FOX report as a possible overdose candidate, but levels required to reach the negative side effects mentioned are between 150-450 mg per day, again requiring a consumer to take several capsules to achieve this. The highest potency I have ever seen (in 35 years) was 75 mg, though 15-50 mg products are relatively common. Yet the median intake among American adults is just over 2/3 of the Daily Value, making deficiencies far more common than overdoses. Again, the FOX report ignored the common, greater danger in favor of sensationalizing a remote possibility of overdosing. Zinc is essential for many biochemical reactions in the body, and is most notably associated with immune function and wound healing. Yet isn’t FOX essentially warning people against taking zinc, hinting that they may be in danger but without any hint of the true risks and benefits? A dietician in the report stated that there is no proof that taking extra vitamin C shortens or prevents colds. That should come as news to the researchers at the University of Pittsburgh Medical Center. Publishing results of a Review Study in the medical journal American Family Physician in February 2007, these physicians reported that, “Thirty trials involving 9,676 cold episodes showed a statistically significant decrease in illness duration with vitamin C taken before onset of symptoms…. Likewise, 15 trials involving 7,045 cold episodes demonstrated a decrease in severity scores and in days confined to the home.” While there is some little evidence (not none) that vitamin C can prevent the incidence of colds, there is significant evidence that it can shorten the duration and severity of colds. Don’t you think that the FOX report is irresponsible by highlighting rare nutrient overdoses while ignoring common deficiencies? Also, why would one person’s opinion that vitamin C is worthless against colds trump the collective evidence of 30 clinical studies that met the strict criteria of a review study? Given these gross errors, I suggest that FOX assigns fact-checkers to review all medical and health reports. Let’s put an end to the flawed practice of naively taking the word of health professionals who appear not be up-to-date on what’s published in the medical literature. This is most important when demonstrably false blanket statements are made that inappropriately dismiss the safety and efficacy of essential nutrients that are known to be deficient in most Americans’ diets. REFERENCES: http://www.myfoxchicago.com/myfox/pages/Home/Detail;jsessionid=BF06BF0BCA71AE327C05A6BA65DEB517?contentId=5757535&version=2&locale=EN-US&layoutCode=VSTY&pageId=1.1.1&sflg=1 Vitamin E Fact Sheet NIH Office of Dietary Supplements Zinc Fact Sheet NIH Office of Dietary Supplements “Thirty trials involving 9,676 cold episodes showed a statistically significant decrease in illness duration with vitamin C taken before onset of symptoms: an 8 percent decrease (95% confidence interval [CI], 3 to 13 percent) in adults and a 13.5 percent decrease (95% CI, 5 to 21 percent) in children. Likewise, 15 trials involving 7,045 cold episodes demonstrated a decrease in severity scores and in days confined to the home. Vitamin C did not decrease the incidence of cold in the general population. However, a subgroup of six trials involving runners, skiers, and soldiers participating in subarctic exercises demonstrated a 50 percent relative reduction in the risk of developing a cold (95% CI, 32 to 62 percent).” Simasek M, Blandino DA. Treatment of the common cold. Am Fam Physician. 2007 Feb 15;75(4):515-20. Review. PMID: 17323712 [PubMed - indexed for MEDLINE]. Hathcock JN, et al. Vitamins E and C are safe across a broad range of intakes. Am J Clin Nutr. 2005 Apr;81(4):736-45. Review. PMID: 15817846 [PubMed - indexed for MEDLINE] Dial S, Eitenmiller RR. 1995. Tocopherols and tocotrienols in key foods in the U.S. diet. In: Ong ASH, Niki E, Packer L, eds. Nutrition, Lipids, Health, and Disease. Champaign, IL: AOCS Press. Pp. 327–342. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000). Institute of Medicine JASPREET K.C. AHUJA, JOSEPH D. GOLDMAN, and ALANNA J. MOSHFEGH. Current Status of Vitamin E Nutriture. Ann NY Acad Sci 2004 1031: 387-390. Erwin RB, et al. Dietary intake of selected minerals for the United States population: 1999-2000. Adv Data. 2004 Apr 27;(341):1-5. PMID: 15114720 [PubMed - indexed for MEDLINE] Meydani SN, et al. Vitamin E and respiratory tract infections in elderly nursing home residents: a randomized controlled trial. JAMA. 2004 Aug 18;292(7):828-36. Erratum in: JAMA. 2004 Sep 15;292(11):1305. JAMA. 2007 May 2;297(17):1882. PMID: 15315997 [PubMed - indexed for MEDLINE] Meydani SN, Han SN, Hamer DH. Vitamin E and respiratory infection in the elderly. Ann N Y Acad Sci. 2004 Dec;1031:214-22. Review. PMID: 15753147 [PubMed - indexed for MEDLINE]

The critical condition of patients admitted to the ICU is associated with worsening oxidative stress.

The critical condition of patients admitted to the ICU is associated with worsening oxidative stress, according to a medical journal article. "A major finding of the study was that administration of antioxidant vitamins at between 66% and 100% of RDA can reduce the risk for oxidative stress by 94%..." "...dietary enteral supplementation with vitamins C and E for 10 days prevented lipid peroxidation and oxidative stress in critical care patients and significantly influenced their clinical outcome at 28 days." "Greater depletion of antioxidants has been related to a greater severity of trauma, systemic inflammatory response syndrome, or sepsis." full article is available at: http://ccforum.com/content/10/5/R146

Are antioxidants worthless against heart disease?

Are antioxidants worthless against heart disease? By Neil E. Levin, CCN, DANLA 8/15/07 In a published report, A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women (Results From the Women’s Antioxidant Cardiovascular Study), researchers concluded that, “There were no overall effects of ascorbic acid (vitamin C), vitamin E, or beta carotene on cardiovascular events among women at high risk for CVD.” (1) This is simply untrue. In order to reach that conclusion, the researchers had to count non-compliant subjects as taking vitamin E, even when it was obvious that they weren’t following the study protocol. Is that intellectually honest? I would have given the opposite conclusion. When subjects assigned to take vitamin E actually took their vitamin E, the results were significant and proved that the vitamin had benefits: “Censoring participants on noncompliance led to a significant 13% reduction in the primary end point…Reductions in secondary study end points were also stronger, with a 22% reduction in MI … a 27% reduction in stroke … and a 9% reduction in CVD mortality … There was a 23% reduction in the combination of MI, stroke, or CVD death…Among those with prior CVD, the active vitamin E group experienced fewer major CVD events …” [-11%] "A marginally significant reduction in the primary outcome with active vitamin E was observed among the prespecified subgroup of women with prior cardiovascular disease (RR, 0.89; 95% CI, 0.79 - 1.00 [P = .04]; P value for interaction = .07). There were no significant interactions between agents for the primary end point, but those randomized to both active vitamins C and E experienced fewer strokes (P value for interaction = .03)." Why did the researchers gloss over these admitted benefits (that those assigned to take vitamin E who actually did take it had "significant" benefitsand those with prior CVD who took the relatively low levels of C plus E experience fewer strokes)? This was wholly ignored in the study's conclusion, as well as the subsequent press release and extensive news coverage. I have found and published (2) criticisms of this particular failing (reaching improper conclusions not truly supported by the data) before: (3-10) REFERENCES: 1. Cook N, et al. A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women. ARCH INTERN MED. VOL 167 (NO. 15), AUG 13/27, 2007 2. Levin N. Land of Confusion: How Poor Science and Misleading Media Coverage Create Public Confusion About How Dietary Supplements Affect Health. J App Nutr, Vol 55, No. 1, 2005 8-15 3. Edgar R. Miller, III, MD, PhD; et al. High-dose vitamin E supplementation may increase all-cause mortality, a dose response meta-analysis of randomized trials. Annals of Internal Medicine: Online: Nov. 10, 2004: Print: 4 January 2005 | Volume 142 Issue 1 4. A study conducted by USA Today found that more than half of the experts hired to advise the government on the safety and effectiveness of medicine had a direct financial interest in the drug or topic they were asked to evaluate. An analysis of financial conflicts of interest at 159 FDA advisory committee meetings from January 1, 1998, through June 30, 2000, found that at 92% of the meetings, at least one member had a financial conflict of interest, while at 55% of meetings, half or more of the FDA advisers had conflicts of interest. These conflicts included helping a pharmaceutical company develop a medicine, then serving on an FDA advisory committee that judges the drug. 5. Lonn E, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005 Mar 16;293(11):1338–47. PMID: 15769967 6. Blumenthal M, Farnsworth NR. Echinacea angustifolia rhinovirus infections [letter]. N Engl J Med. Nov.3, 2005;353(18):1971–1972. 7. 21 C.F.R. Pt. 119, Final Rule Declaring Dietary Supplements Containing Ephedrine Alkaloids Adulterated Because They Present an Unreasonable Risk (Published February 11, 2004) (Effective April 12, 2004) available at http://www.fda.gov/ohrms/dockets/98fr/1995n-0304-nfr0001.pdf 8. Taylor JA, Weber W, Standish L, Quinn H, Goesling J, McGann M, Calabrese C. Efficacy and safety of Echinacea in treating upper respiratory tract infections in children: A randomized controlled trial. J Amer Med Assn Dec 3, 2003;290(21):2824–30. 9. Fugh-Berman A, Myers A. Citrus aurantium, an ingredient of dietary supplements marketed for weight loss: current status of clinical and basic research. Exp Biol Med (Maywood). 2004 Sep;229(8):698–704. Review. PMID: 15337824 10. Effects of Long-term Vitamin E Supplementation on Cardiovascular Events and Cancer. JAMA. Vol. 293 No. 11, Vol. 293 No. 11, March 16, 2005

The China Syndrome: Where do your vitamins come from?

The China Syndrome: Where do your vitamins come from? By Neil E. Levin, CCN, DANLA A large number of people have been recently asking whether dietary supplement ingredients come from China, with the implication that everything from China is dangerous and adulterated. Some have been misinformed, being told that most supplements originate in China and that there may be some reason to worry about them. These people are scared and some even promise to stop buying any product made in China. How valid is this fear? While it is true that much of the domestic vitamin C supply comes from China, that is not true for most ingredients in American dietary supplements. And, believe me, American vitamin manufacturers have long been wary about buying cheap, generic ingredients from China. It has taken a lot of time and successful testing of materials for Chinese ingredients such as vitamin C to eventually penetrate the American market. Some Chinese suppliers have demonstrated a dedication and history of quality manufacturing, which in turn has established a measure of confidence in their American and European customers. These are not a few “bad apples” that are trying to sell substandard ingredients to us. These are the tried and true good guys that have a devotion to quality. Why punish them for the mistakes and misdeeds of Chinese pet food manufacturers? Guilt by association has never been my favorite prejudice. In fact, the Natural Products Association (NPA) has inaugurated a new Chinese affiliate organization, with the express purpose of establishing pre-testing and certification of select Chinese dietary supplement ingredients before they are shipped to the US. This is yet another measure intended to protect the American public by testing and screening raw materials intended for the US market. Joint ventures with European and Japanese manufacturers has recently placed brand new, state-of-the-art pharmaceutical-grade production facilities in China that meet the same exacting standards as US, European or Japanese plants that have long been associated with the highest quality ingredients. These new plants are registered with the FDA and meet current good manufacturing practices for pharmaceuticals (cGMP), with some facilities also registered as ISO compliant and kosher certified. These are not shady operations, and in some cases exceed the quality standards of older Western facilities. You could walk through them and feel like you were in a top pharmaceutical plant in Switzerland. The best US manufacturers, those who have earned the coveted GMP certification for good manufacturing practices, have quality control programs in place to evaluate both suppliers and ingredients. Testing provides a means to ensure that both vendors and ingredients are identified and approved before use. In the case of vitamin C, testing to assure that the material meets strict US standards of quality and identity for pure L-ascorbic acid is a key control point, with the material typically meeting pharmaceutical monographs for purity standards. Microbiological screening is another quality measure employed by some US manufacturers to assure safety in plant and animal derived ingredients. And some manufacturers actually help to advance the science of quality by publishing validated test methods in peer-reviewed scientific journals. These new methods include recent publications for advancing the testing of unadulterated glucosamine and chondroitin. I have a fear that the enemies of dietary supplement use and American health freedom have irresponsibly cooked up this campaign of fear to swamp US supplement companies with requests for country-of-origin information for every ingredient and to waste both their and their customers’ time chasing a red herring. As we have seen no indication of any specific problem with dietary supplements (other than television pundits apparently trying to morph legitimate pet food fears into unfounded fears of possibly tainted supplements), someone is obviously riling up American consumers in an effort to create doubts about the safe use of vitamins. Who stands to gain from this fear-mongering? The news media obviously thrives on sensational reports that make us question everyday conveniences. The medical/pharmaceutical complex is another obvious beneficiary of people being afraid to use vitamins. Self-appointed consumer advocates think that they can reduce risks by getting people to avoid “unproven” and “unregulated” natural products and therapies, hoping to get them to use “safe” medical therapies instead. These folks have failed to read the annual reports of the American Associations of Poison Control Centers, which prove that even lip balms and household cleaners are more deadly than vitamins. Don’t be fooled by reports of vague dangers from Chinese ingredients used in American dietary supplements sold by large, reputable US manufacturers. Until there is some basis in fact, I regard this as strictly a cynical attack by enemies of natural products, intended to erode our resolve to making better health choices, including the use of dietary supplements. If we fear to take our supplements, we will abandon them and be left with drugs as our only means to correct health problems amplified by nutritional deficiencies, often caused or aggravated by by our poor diets. And since over 90% of Americans fail to eat even the minimal RDA levels of nutrients, that means you!

Another Decade of AIDS (HIV)

In 1995 a protocol for nutritional support of people who were HIV positive was published by a nutrition group headed by Willis H. Reisen, PhD, who received his PhD in biochemistry from the University of Wisconsin in the 1950's and was board certified as a clinical nutritionist in the early 1990's. Dr. Reisen, and his colleague David B. Tardy, self-published their short pamphlet, A Decade of AIDS, after a ten-year period during which they claimed that not a single one of the approximately one hundred HIV-positive people following this protocol had gone from HIV-positive to full-blown AIDS. (Both of these good gentlemen have since passed away at a ripe age.)

I am providing the recommendations of their original protocol in a very short form largely for historical purposes, but also to open people's minds to the possibilities of using nutrition to complement conventional medical care. I'm also providing independent scientific references that I have dug up to document the current science backing up their original protocol, which I present below.

A bit of explanation of the supplemental options was also added by me, along with a few examples of modern formulas providing these nutrients more efficiently than those available on the market some 10-12 years ago.

Please remember that this protocol was designed to be used under a physician's care, and should NOT be used as a substitute for medical care!

HIV nutritional support protocol (to be used only under the medical supervision of a physician):

This protocol has traditionally (since 1985) been used by some clinical nutritionists for the nutritional support of people with HIV for nutritional restoration of the digestive and immune systems. Use this protocol only as directed by your physician.

Nutritional Protocol:

• Probiotics include acidophilus, bifidus, and other ‘beneficial bacteria’ that are healthy for the human gut. If you are not using an antibiotic prescription drug, simply take a good quality, strong probiotic formula as directed on the label. If you are currently taking an antibiotic prescription drug, supplement with a good quality, strong probiotic formula an hour or two after each dose of antibiotic, then continue taking the probiotics for some weeks after the antibiotic course is over.
• Take a good hi-potency multiple vitamin to provide basic nutritional supplementation.1, 2, 17-33, 45
• Take antioxidants to increase detoxification and glutathione production. Cysteine or NAC 3,4, whey protein isolate 34-36, GliSODin ™ 37, 39-44 Silymarin (milk thistle extract) VitaBerry™ or other hi-ORAC antioxidant formula Selenium, preferably selenomethionine, 200-400 mcg/day. 5-8, 39
• Do a Vitamin C flush, maintaining appropriate levels: http://www.askrph3.com/healthcare/article_cflush.shtml 9-11, 38
• Natural carotenoids 46-48 AIDS-related weight loss and chronic diarrhea ("HIV enteropathy") may respond to a gluten-free diet. 12
• Progressive resistance training (weight training) and exercise may be used as an alternative or adjunct to steroids. 13,14
• DHEA may alleviate fatigue and depression (200-500 mg per day for eight weeks). DHEA supplementation had no effect on CD4 cell (helper T-cell) counts or testosterone levels. 15,16

References
1. Ince S. Vitamin supplements may help delay onset of AIDS. Med Tribune 1993;9:18.
2. Fawzi WW, Msamanga G, Hunter D, et al. Randomized trial of vitamin supplements in relation to vertical transmission of HIV-1 in Tanzania. J Acquir Immune Defic Syndr 2000;23:246–54.
3. Roederer M, Staal FJ, Raju PA, et al. Cytokine-stimulated human immunodeficiency virus replication is inhibited by N-acetyl-L-cysteine. Proc Natl Acad Sci 1990;87:4884–8.
4. Herzenberg LA, De Rosa SC, Dubs JG, et al. Glutathione deficiency is associated with impaired survival in HIV disease. Proc Natl Acad Sci 1997;94:1967–72.
5. Baum MK, Shor-Posner G, Lai S, et al. High risk of HIV-related mortality is associated with selenium deficiency. J Acquir Immune Defic Syndr Hum Retrovirol 1997;15:370–4.
6. Olmsted L, Schrauzer GN, Flores-Arce M, Dowd J. Selenium supplementation of symptomatic human immunodeficiency virus infected patients. Biol Trace Elem Res 1989;25:89–96.
7. Chariot P, Perchet H, Monnet I. Dilated cardiomyopathy in HIV-infected patients [letter; comment]. N Engl J Med 1999;340:732 (discussion 733–5).
8. Zazzo JF, Lafont A, Darwiche E, et al. Is non-obstructive myocardiopathy (NOMC) in AIDS selenium-deficiency related? In: Neve J, Favier A, eds. Selenium in biology and medicine. W. DeGruyter & Co.: Berlin New York, 1988, 281–2.
9. Harakeh S, Jariwalla RJ, Pauling L. Suppression of human immunodeficiency virus replication by ascorbate in chronically and acutely infected cells. Proc Natl Acad Sci 1990;87:7245–9.
10. Tang AM, Graham NMH, Saah AJ. Effects of micronutrient intake on survival in human immunodeficiency type 1 infection. Am J Epidemiol 1996;143:1244–56.
11. Cathcart RF III. Vitamin C in the treatment of acquired immune deficiency syndrome (AIDS). Med Hypotheses 1984;14:423–33.
12. Nellen H, Flores G, Wacher N. Treatment of human immunodeficiency virus enteropathy with a gluten-free diet. Arch Intern Med 2000;160:244 [letter].
13. Roubenoff R, McDermott A, Weiss L, et al. Short-term progressive resistance training increases strength and lean body mass in adults infected with human immunodeficiency virus. AIDS 1999;13:231–9.
14. Mustafa T, Sy FS, Macera CA, et al. Association between exercise and HIV disease progression in a cohort of homosexual men. Ann Epidemiol 1999;9:127–31.
15. Ferrando SJ, Rabkin JG, Poretsky L. Dehydroepiandrosterone sulfate (DHEAS) and testosterone: relation to HIV illness stage and progression over one year. J Acquir Immune Defic Syndr 1999;22:146–54.
16. Rabkin JG, Ferrando SJ, Wagner GJ, Rabkin R. DHEA treatment for HIV + patients: effects on mood, androgenic and anabolic parameters. Psychoneuroendocrinology 2000;25:53–68.
17. Semba RD, Graham NMH, Caiaffa WT, et al. Increased mortality associated with vitamin A deficiency during human immunodeficiency virus type 1 infection. Arch Intern Med 1993;153:2149–54.
18. Semba RD, Miotti PG, Chiphangwi JD, et al. Maternal vitamin A deficiency and mother-to-child transmission of HIV-1. Lancet 1994;343:1593–7.
19. Coutsoudis A, Pillay K, Spooner E, et al. Randomized trial testing the effect of vitamin A supplementation on pregnancy outcomes and early mother-to-child HIV-1 transmission in Durban, South Africa. South African Vitamin A Study Group. AIDS 1999;13:1517–24.
20. Kennedy CM, Coutsoudis A, Kuhn L, et al. Randomized controlled trial assessing the effect of vitamin A supplementation on maternal morbidity during pregnancy and postpartum among HIV-infected women. J Acquir Immune Defic Syndr 2000;24:37–44.
21. Fawzi WW, et al. (2004). A randomized trial of multivitamin supplements and HIV disease progression and mortality. N Engl J Med 351, 23–32
22. Coutsoudis A, Bobat RA, Coovadia HM, et al. The effects of vitamin A supplementation on the morbidity of children born to HIV-infected women. Am J Public Health 1995;85:1076–81.
23. Kanter AS, Spencer DC, Steinberg MH, et al. Supplemental vitamin B and progression to AIDS and death in black South African patients infected with HIV. J Acquir Immune Defic Syndr 1999;21:252–3 [letter].
24. Butterworth RF, Gaudreau C, Vincelette J, et al. Thiamine deficiency in AIDS. Lancet 1991;338:1086.
25. Baum MK, Mantero-Atienza E, Shor-Posner G, et al. Association of vitamin B6 status with parameters of immune function in early HIV-1 infection. J Acquir Immune Defic Syndr 1991;4:1122–32.
26. Tang AM, Graham NMH, Saah AJ. Effects of micronutrient intake on survival in human immunodeficiency type 1 infection. Am J Epidemiol 1996;143:1244–56.
27. Boudes P, Zittoun J, Sobel A. Folate, vitamin B12, and HIV infection. Lancet 1990;335:1401–2.
28. Murray MF. Niacin as a potential AIDS preventive factor. Med Hypotheses 1999;53:375–9.
29. Murray MF, Srinivasan A. Nicotinamide inhibits HIV-1 in both acute and chronic in vitro infection. Biochem Biophys Res Commun 1995;210:954–9.
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Response to NPR report on supplements and colds

Stress, Nutrition and Colds By Neil E. Levin, CCN, DANLA, January 11, 2007 The NPR Morning Edition story airing today called “Low-Stress Life May Be Best Way to Prevent Colds” has some contradictions and inaccuracies. While I can’t defend the “Airborne” formula, which has non-standardized herbs and non-natural ingredients and was developed by a teacher rather than a nutritionist, some of the statements about dietary supplements made in the report are simply inaccurate. One is the purported lack of connection between boosting the immune system and preventing or treating the common cold or flu, reporting the views of one skeptical medical researcher. In fact, there are many hundreds of published clinical studies showing specific mechanisms by which various dietary supplements can improve immune cell function. A review of the published science on zinc in the Journal of Environmental Pathology and Toxicology stated that “[zinc] fulfills an immune function.” The Journal of Applied Microbiology and Biotechnology published a review reporting that, “Garlic has a wide spectrum of actions; not only is it antibacterial, antiviral, antifungal and antiprotozoal, but it also has beneficial effects on the cardiovascular and immune systems.” Alternative Medicine Review recently published a review of the literature on the effects of herbs on the immune system, reporting, “The in vitro and in vivo research demonstrates that the reviewed botanical medicines modulate the secretion of multiple cytokines.” [immune cells] And the journal Autoimmunity bluntly reported on Echinacea’s positive effect on Natural Killer immune cells, indicating that Echinacea may even provide a new treatment for Type 1 Diabetes: “the fact that the herb, Echinacea, is a well demonstrated immunostimulant of NK cells in normal mice/humans,” and concluding that “The results revealed that, in NOD mice, dietary Echinacea…actually stimulated NK cell production in their bone marrow birth site.” Another mistaken claim is that “most people get plenty of that [Vitamin C] in their diet. Yet according to dietary data from the National Health and Nutrition Examination Survey, “We conclude that despite NHANES III data indicating a small increase in the median dietary vitamin C ingestion in the USA, a substantial fraction of the population still ingests vitamin C at or below the Recommended Dietary Allowance.” The RDA is only 60 mg a day. This links to another part of the report that links stress to a two-fold increase in colds. Vitamin C aids adrenal function, with that gland being the most prominent player in stress response. Vitamin C levels in the adrenal gland are reported to be as great as 150 times the general levels in the bloodstream. Of course, if people don’t get enough in the diet and are under stress, that easily explains the vitamin C connection. The report also stated that some formulas contain, “herbs such as Echinacea, which, although very popular, has been shown by the best scientific studies not to work.” Yet recent negative reports have been challenged by the non-profit American Botanical Council (ABC) as not using commercially available preparations and using lower doses less frequently than commonly and previously used in positive studies. Another criticism is that some studies used college students that typically have better immune system functioning than elderly people. ABC Executive Director Mark Blumenthal said in response to one recent study that, “This is not a definitive trial on the efficacy of echinacea, nor should the results be generalized to echinacea preparations widely available. Unfortunately, the conclusion that may be drawn by some media who report this study may state that ‘echinacea is ineffective,’ but this would be an incorrect conclusion based on the design of this study and the evidence in the existing literature.” A meta-analysis of previously published studies on echinacea was published in the journal Clinical Therapeutics, with the conclusion, “Based on the analysis, the likelihood of experiencing a clinical cold was 55% higher with placebo than with Echinacea.” Another published review says that, “Numerous clinical trials have been carried out on echinacea preparations: it appears that the extracts shorten the duration and severity of colds and other upper respiratory infections (URIs) when given as soon as symptoms become evident.” The NPR report also questions the ability of the mineral zinc to reduce colds. Yet a report by the physician-reviewed health education group A.D.A.M. (http://www.adam.com/) states, “Several important studies have revealed that zinc lozenges may reduce the intensity of the symptoms associated with a cold, particularly cough, and the length of time that a cold lingers.” Such misleading statements in a health report may lead people to think that there are no dietary supplements that can correct deficiencies and imbalances which, combined with stress, may lead to impaired immune function. But science shows that the opposite may be true: dietary supplements have a solid role in immunity and health. Neil Levin is a board certified clinical nutritionist who is a product formulator and the nutrition educator for NOW Foods, a manufacturer of dietary supplements. His nutrition blog is available at http://www.honestnutrition.com/ REFERENCES: Link to original NPR report: http://www.npr.org/templates/story/story.php?storyId=6797207 Frassinetti S, Bronzetti G, Caltavuturo L, Cini M, Croce CD. The role of zinc in life: a review. J Environ Pathol Toxicol Oncol. 2006;25(3):597-610. Review. PMID: 17073562 Harris JC, Cottrell SL, Plummer S, Lloyd D. Antimicrobial properties of Allium sativum (garlic). Appl Microbiol Biotechnol. 2001 Oct;57(3):282-6. Review. PMID: 11759674 Spelman K, Burns J, Nichols D, Winters N, Ottersberg S, Tenborg M. Modulation of cytokine expression by traditional medicines: a review of herbal immunomodulators. Altern Med Rev. 2006 Jun;11(2):128-50. Review. PMID: 16813462 Schoop R, Klein P, Suter A, Johnston SL. Echinacea in the prevention of induced rhinovirus colds: a meta-analysis. Clin Ther. 2006 Feb;28(2):174-83. Review. PMID: 16678640 Block KI, Mead MN. Immune system effects of echinacea, ginseng, and astragalus: a review. Integr Cancer Ther. 2003 Sep;2(3):247-67. Review. PMID: 15035888 Delorme D, Miller SC. Dietary consumption of Echinacea by mice afflicted with autoimmune (type I) diabetes: effect of consuming the herb on hemopoietic and immune cell dynamics. Autoimmunity. 2005 Sep;38(6):453-61. PMID: 16278152 Herbal Science Group Says Dosage Too Low in New Echinacea Trial http://www.herbalgram.org/default.asp?c=echinacea072605 Patak P, Willenberg HS, Bornstein SR. Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla. Endocr Res. 2004 Nov;30(4):871-5. Review. PMID: 15666839 Kurugol Z, Akilli M, Bayram N, Koturoglu G. The prophylactic and therapeutic effectiveness of zinc sulphate on common cold in children. Acta Paediatr. 2006 Oct;95(10):1175-81. PMID: 16982486 Hulisz D. Efficacy of zinc against common cold viruses: an overview. J Am Pharm Assoc (Wash DC). 2004 Sep-Oct;44(5):594-603. Review. PMID: 15496046