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Vitamins, minerals, and antioxidants are called micronutrients. Even though the body only needs small amounts, micronutrients are essential for good health. Our bodies use them in the different chemical reactions our cells go through as part of the body's normal functions. While some people get the nutrients they need through a healthy, balanced diet, many people living with HIV (HIV+) need more micronutrients to help heal cells damaged by the virus and support the immune system. Several studies have shown that taking micronutrient supplements can help keep people living with HIV healthier longer.
Vitamins generally fall into one of two categories: (1) fat-soluble, or those that dissolve in fats, and (2) water-soluble, or those that dissolve in water.
When you take in fat-soluble vitamins (through foods or supplements), your body uses what it needs and stores the rest. Fat-soluble vitamins include vitamins A, D, E, and K. It is important not to take too much of these vitamins because they can build up in the body and cause harmful side effects. For example, too much vitamin A (betacarotene) can cause nausea, blurred vision, birth defects, and liver problems.
When you take in water-soluble vitamins, such as B vitamins and vitamin C, your body uses what it needs and filters out the extra into your urine. Side effects from water-soluble vitamins are less common, but can occur. For example, large doses of vitamin C can cause nausea, stomach cramps, and diarrhea.
Minerals form the structures in the body (calcium in bone, iron in blood) and play a role in the normal functioning of nerves, muscles, and hormones. Several minerals, including zinc, selenium, and iron have a role in fighting HIV. The role of calcium is especially important for women during the time around menopause (perimenopause) and after menopause.
The body produces molecules called free radicals as part of its normal functioning. Free radicals can damage your body's cells. Certain factors, like infection, pollution, and cigarette smoke can increase the number of free radicals in the body. Antioxidants can keep the extra free radicals from causing damage. Some vitamins, including vitamin C and vitamin E, are antioxidants. Beta-carotene (vitamin A) and selenium are also antioxidants.
While micronutrients can be found in foods, some people living with HIV cannot meet all their nutrient needs through their diet. People living with HIV who do not to get enough micronutrients may not get them for a number of reasons: because of HIV infection itself, changes in metabolism, poor appetite, diarrhea, poor absorption of nutrients, or HIV-related conditions such as HIV wasting and AIDS.
Micronutrients that are often low in people living with HIV include vitamin A, vitamin D, vitamin E, selenium, zinc, and B complex vitamins (B1, Thiamine; B2, Riboflavin; B3, niacin; B6, Pyridoxine; B12, Cobolamin; and B9, folic acid). Some research shows these low vitamin levels can lead to lower CD4 cell counts and worsening of HIV. They can also cause problems like diarrhea, neuropathy, and skin conditions.
In resource-poor countries, many women do not get enough micronutrients because they do not have access to enough food or good-quality foods. Yet even in resource-rich countries, it is possible to eat well, feel fine, and still not be getting enough of certain vitamins, minerals, and antioxidants.
The Recommended Dietary Allowance (RDA) guidelines are set by the US government to let people know how much of each micronutrient they need each day to maintain good health. Due to dieting, eating unhealthy foods, lack of time, or other pressures, half of all women in the US do not eat what they need to meet even the basic RDA requirements for folic acid, iron, zinc, calcium, magnesium, copper, vitamins A, D, E, and certain B vitamins. This puts women, especially women living with HIV, at particular risk for low levels of micronutrients. In addition, women are more likely not to get enough nutrients because of menstruation, pregnancy, and menopause
Eating a well-balanced diet should be the basis of any plan to correct micronutrient deficiencies. Since different vitamins and minerals are found in different food groups, it is important to include foods from each group in your diet every day. (Read more about food groups at the USDA's "Choose My Plate" website.)
- Protein group – Healthy foods from this group include lean red meats, skinless chicken or turkey, fish, nuts, peanut butter, soy products, seeds, beans, quinoa, and peas
- Grains group – Healthy foods from this group include whole grain breads, whole grains like oats and wheat, oatmeal, and brown rice
- Fruit group – Any fresh fruit is a good choice
- Vegetable group – Fresh and frozen vegetables are the best
- Dairy group – Try to choose one percent or skim (non-fat) milk, low-fat yogurt and cottage cheese, and small amount of cheeses
For more information, see The Well Project's article on nutrition.
It is important to get as many of the vitamins and minerals you need from food as possible. This is because nutrients found in food are better for your body than nutrients found in supplements. While supplements do not replace a well-balanced diet, they can help you get the additional micronutrients you need. Supplements include vitamins, minerals, herbs, and other related products used to boost the nutritional content of your diet. Supplements are available in pill, capsule, tablet, powder, or liquid form.
Speak to your health care provider and see a registered dietician for a nutritional evaluation. They can help you determine what combination of diet changes and supplementation you need.
Here are some basic recommendations:
- Take a multivitamin/multimineral supplement (without extra iron) every day
- Multivitamins should be taken with food and a full glass of water to help absorption and prevent stomach upset
- Consider a B complex vitamin and an antioxidant supplement in addition to your multivitamin. If you are vegetarian, consider getting your vitamin B12 level checked; if it is low, it is important to ask your provider for the correct amount of B12 to take.
- Because women are at higher risk for bone disease, make sure you are getting 1,000 milligrams of calcium (1,200 milligrams if you are over 50) from foods or supplements each day. Women who are menopausal do not have the estrogen levels to support new bone growth. If you are menopausal, it is important for you to take calcium supplements for the rest of your life.
- Humans make vitamin D by being outdoors and exposing our skin to the sun. Many people are low in vitamin D, which is important for absorbing and using calcium. It is important to have your vitamin D level checked and to ask your provider for the correct amount of vitamin D to take if your level is low. The RDA for vitamin D is 600 units (or 15 micrograms) per day.
- Iron may be too low in women, especially during their menstrual periods. This can lead to anemia. However, it is not recommended that people living with HIV take extra iron without their health care provider's advice.
- Because studies have shown that St. John's Wort (Hypericum perforatum) affects the levels of protease inhibitors and non-nucleoside reverse transcriptase inhibitors in the blood, the US Food and Drug Administration (FDA) recommends that those taking any HIV drugs not take St. John's Wort. St. John's Wort is an herb commonly used as an anti-depressant.
- If you are planning to get pregnant, speak to your health care provider about prescription pregnancy vitamins that contain folic acid. Folic acid needs to be taken before becoming pregnant, since the first six to eight weeks of pregnancy is the most important time for folic acid to protect the developing baby’s nervous system.
You may also want to consider:
- Alpha-lipoic acid: for its antioxidant properties and diabetic neuropathy. Suggested dose: 20-50 mg per day for general antioxidant properties, 200-300 mg per day for diabetic neuropathy. Reportedly tolerated well up to 600 mg per day.
- Carnitine (also called acetyl-L-carnitine): to support proper metabolism. It may also help with neuropathy. Suggested dose: 500 mg to 3000 mg (3 g) per day.
- Coenzyme Q10: acts as an antioxidant and supports immune function. Suggested dose: 30-200 mg per day.
- Cysteine (also called N-acetyl-L-cysteine, or NAC): the body converts cysteine to glutathione, a powerful antioxidant. Suggested dose of NAC: 500 mg per day to start; people living with HIV may take up to 4,000 mg per day, with your health care provider's supervision.
- Probiotic supplement: these contain "healthy bacteria" like acidophilus to support digestion and immune health. Having healthy bacteria in your gut helps your body absorb more nutrients and make the most of what you eat. A suggested dose of Lactobacillus acidophilus (L. acidophilus), one of the most common probiotics, is one to two billion colony-forming units (CFUs). The dose depends on the health condition being treated. Those using probiotics may take as many as 15 billion CFUs per day for intestinal health with their health care provider's supervision.
Because of the potential for side effects and interactions with medications, supplements should be taken only under the supervision of a knowledgeable health care provider.
Deciding which supplements to take can be difficult and confusing because there are so many different kinds on the market. Try not to make your selections based on price, fancy or expensive packaging, or product promises. Instead, read the label to see what is really inside.
Micronutrients are essential to your body's healthy functioning. However, making sure you get enough nutrients without taking too much can be tricky. You can play it safe by speaking to your health care provider or an HIV-knowledgeable dietician about what supplements to take and possible side effects or interactions with your HIV drugs.