VITAMINTESTING.COM: Vitamin Deficiency Test Information

By Craig Arnoff, VitaminTesting.com Publisher – June 26, 2007
      
This is a continuation of Case Study #1C in which “Al” (all names changed to protect privacy) wrote to the registered dietician his physician said was more knowledgeable than he about dietary supplements.  Now, the dietician responds. 

Note that again, studies showing vitamin deficiencies in HIV patients were discounted because they were conducted in third-world countries.  Yet, neither the doctor nor dietician could provide evidence of studies conducted in the U.S. which either disproves the other studies or indicates that HIV patients do NOT have similar vitamin deficiencies.  In fact, there is a body of evidence, albeit not from large-scale studies, that vitamin deficiencies are prevalent in HIV patients.

Also note that the actual testing of vitamin levels was not recommended because vitamin-testing panels were not available at the institution’s laboratory and insurance was said to be unlikely to pay for the tests.  Lastly, the dietician acknowledges that when supplements are recommended, it’s often based on educated “hunches” or general-population studies.   

=============== LETTER FROM THE DIETICIAN TO AL ===============

Hi Al,

Very good questions.  Unfortunately all of the studies regarding vitamin/mineral deficiencies in HIV patients that I’ve read have been in third world countries on malnourished individuals who have poor food access.   I checked on the labs test available at our hospital and, unfortunately, they don’t have a vitamin/mineral blood panel.  Each test must be ordered separately and most aren’t covered by insurance.  For example, there is no selenium test here, and that’s one of the common HIV-related deficiencies cited in the third-world studies. Malabsorption can involve both macronutrients such as protein, carbohydrates and fat as well as micronutrients which are vitamin and minerals.  An indication of serious malabsorption problems is that you cannot maintain a healthy weight.  If you can maintain a healthy weight for your height, then you likely don’t have major malabsorption issues.  The most serious malabsorption occurs with chronic diarrhea.  In that case, the diarrhea should be resolved rather than overloading the person with extra vitamin/mineral supplements. So, because of the lack of first world studies, it makes my job more difficult when it comes to recommending supplementation.  I like my recommendations to be based on evidence-based research.  More often they have to be based on a hunch or general population studies (not HIV only).

So, here’s what I would recommend based on not getting a full medical history from you.  Take 2 general multivitamins each day.  One in the morning and one before bed.  You may have also heard of KPAX.  These supplements contain extra ingredients that are not found in a general multivitamin and are thought to have a beneficial affect on HIV status although a study that was done on this supplement, which showed improved CD4 count, wasn’t well designed and had a small number of participants.  Since the beta carotene levels are pretty high, I wouldn’t recommend more than the single strength dose.  I think this supplement is probably okay but again, it’s based on a hunch and not evidence-based research.

Finally, you can be proactive and do your own research to keep up on the latest studies. Check out www.medscape.com where you type a topic in and it will bring up the latest research.  This information will be more valid than trying to sift through all the wacky stuff if you did a google search.  When you read a study, look at the sample size (how many people were part of the study) and be critical of the methods that were used.  You might type in something like “HIV/AIDS Vitamin Deficiencies”.  This is how I keep up on the latest research.  If you would like to discuss this topic further, I would recommend that you call the clinic and make an appointment to see me.  I can provide you with a full nutritional assessment and recommendations.  Have a great day.

Sally Dietician