Posted 3/16/07CLICK TO PRINT

NAME: Vitamin B Complex
B-1 (Thiamin), B-2 (Riboflavin), B-3 (Niacin), B-5 (Pantethine), B-6 (Pyridoxine),
B-12 / Folic acid, B-12 (Cyanocobalamin), Pantothenic Acid

The B vitamins are commonly referred to as the "B complex" because they are usually found together in foods and have similar functions in the body. They function as coenzymes to catalyze many biochemical reactions in the body. B vitamins are needed to produce the body’s energy because they act with enzymes to convert carbohydrates to glucose, the body’s chief fuel.

They are also important for blood sugar control since they are used in the body’s regulation of the breakdown of glycogen into glucose, an important factor in the body’s ability to maintain normal blood sugars. B vitamin deficiencies can lead to impaired glucose tolerance.

B vitamins are also important for fat and protein metabolism. In addition, they are crucial for the normal functioning of the nervous system, as well as for the health of the skin, hair, eyes, liver, and the body’s mucosal linings (in the lungs, the gastrointestinal tract, etc.).

The B vitamins interact with each other in many ways, and need each other to perform best. Thus, it is always considered best to take a B complex along with any individual B vitamins. Most good multiples contain the entire B complex.

SOURCES: The richest dietary sources of B vitamins are brewer’s yeast, the germ and bran of cereal grains, some beans, peas, nuts, and liver.
B-Right (Jarrow). Each bottle, 100 capsules of B vitamins.
NAME: Vitamin B-1 (Thiamin)
DESCRIPTION: Thiamin is necessary for proper function of the nervous system, and muscles, including the heart muscle.

Thiamin is needed to convert blood sugar (glucose) into biological energy. It is involved in many metabolic reactions, and is needed by the nervous tissue, the heart, the bone marrow (where it is used for the formation of red blood cells), and the muscles that use it for maintenance.

DATA: Recent research has brought a great deal of attention to thiamin since it appears to help protect the mitochondria against the assault of nucleoside analogues, and has been proposed (along with riboflavin) as a counter to mitochondrial dysfunction, even in those who continue taking nukes.
SOURCES: The richest dietary sources of thiamin are whole-grain products, brown rice, seafood, and beans.
NAME: Vitamin B-2 (Riboflavin)
PRODUCT NOTES: Riboflavin is important for healthy skin, mucous membranes, and the production of energy.

It has antioxidant qualities and is involved with the enzyme called glutathione reductase which helps maintain glutathione, the most important intracellular antioxidant. Recent research has brought a great deal of attention to riboflavin since it appears to help protect the mitochondria against the assault of nucleoside analogues, and has been proposed (along with thiamin) as a counter to mitochondrial dysfunction, even in those who continue taking nukes.

SOURCES: The richest dietary sources of riboflavin are milk, cheese, yogurt, green leafy vegetables, fruits, bread, cereals, and meats (particularly organ meats).
NAME: Vitamin B-3 (Niacin or Niacinamide)

Vitamin B-3, more commonly known as niacin, works in the glycogen energy cycle, oxidating fatty acids for energy, and acts as part of two coenzymes (nicotinamide adenine dinucleotide and nicotinamide adenine dinucleotide phosphate) that are involved in more than fifty different metabolic reactions.

The coenzymes help the body break down and use protein, carbohydrates, and fat. B-3 is also needed for the healthy activity of the nervous system and normal brain function, and supports the health of skin, tongue, and digestive tract tissues. It is also needed for the body to produce sex hormones, including estrogen, progesterone, and testosterone.

The most common suggested use for niacin in HIV disease has been as a blood fat lowering agent. Niacin can lower overall cholesterol, LDL cholesterol and triglycerides, and actually works better than the statin drugs to raise HDL cholesterol.

CAUTIONS: There are several potential problems related to this use of niacin. First, the dose of niacin required to lower blood fats is quite high, usually from 1,000 to 3,000 mg daily. Even at much lower dosage levels, many people experience what is called a “niacin flush:” flushing, redness, warmth and, in some people, painful stinging and itching in the face and extremities for a period of a half-hour or more after the niacin is taken.

A sustained-release, "no-flush" form is less likely to cause these problems, especially if combined with a baby aspirin taken 30 minutes before the niacin. Taking it in the middle of a meal will also help. Sustained-release Niaspan®, 500 mg per tablet, can be taken with breakfast and dinner, and, if even that reduced dose causes problems, the tablet can be cut in half.

If the lowered dose is tolerable but insufficient to normalize blood fats, it can be increased until good results are seen, but this increases the risk of niacin’s second important potential problem: liver toxicity. This possibility of toxicity exists even at the 1000 mg daily dose (the minimum dose that is generally necessary for improving blood fats), and increases with higher doses. Liver enzyme tests should be done to watch for such toxicity.

Blood glucose (blood sugar) levels should also be monitored because niacin has the potential to increase insulin resistance and, thus, raise blood sugar. Some experts say that this characteristic makes niacin inadvisable for HAART takers since many people on HAART will develop insulin problems, and that this is particularly true for anyone already showing signs of blood sugar problems.

SOURCES: The richest dietary sources of niacin are lean meats, fish, nuts, and poultry.
Niacin TR (Douglas Labs) Each bottle, 100 capsules, each capsule, 400 mg of a time-released form of niacin (vitamin B3). Please read the cautions noted above.
NAME: Vitamin B-5 (Pantethine or Pantothenic Acid)
FUNCTION: B-5 has multiple roles in energy metabolism, is a coenzyme, and is important for proper neurotransmitter health. It is also known as the “stress vitamin."

Pantethine is the oxidized form of vitamin B5, and is the reactive component of coenzyme A as well as an acyl carrier protein (ACP). These proteins are involved in the regulation of carbohydrate, lipid and amino acid metabolism.

DATA: Very large doses of pantethine have been found to have lipid-lowering effects (for which it is used in Europe and Japan).
Pantethine (Jarrow Formulas) Each bottle, 90 softgels. Each softgel, 300 mg of pantethine. Suggested use is 300 mg (1 capsule) taken three times per day with meals.
NAME: Vitamin B-6 (Pyridoxine and the active Pyridoxal-5-Phosphate)

Vitamin B-6 is essential for amino acid metabolism, hemoglobin formation, and healthy nervous system.

B-6 is required for the production of red blood cells and immune system cells and for the proper function of more than sixty enzymes crucial to many body systems. In addition, it is used in the production of neurotransmitters, the chemicals that the body uses for communication between brain cells and between the brain and the immune system. B-6 is used in the body’s regulation of the breakdown of glycogen into glucose, an important factor in the body’s ability to maintain normal blood sugars.


Deficiencies of B-6, known to be common in people with HIV, can lead to impaired glucose tolerance. B-6 deficiency is also known to cause severe immune suppression while supplementation is known to boost immunity in both humans and animals and also to inhibit the growth of cancer cells. Deficiency can also cause irritability, depression, anxiety, mood disorders, skin rashes, tongue and mouth tenderness, anemia, and, with more advanced deficiency, nausea, vomiting, and seizures.

B-6 deficiencies are also known to cause carpal tunnel syndrome (with symptoms of numbness, tingling, and pain in the hands and wrists) and degeneration of peripheral nerves, and may contribute to some of the peripheral neuropathy problems experienced by many. Higher dosages (perhaps 200-300 mg daily) might be required for treatment of neuropathic symptoms.

Deficiencies of B-6 are also known to cause a variety of skin problems and supplementation with B-6 has been seen to help resolve seborrheic dermatitis, eczema, skin rashes, and acne-type outbreaks, problems experienced by many people with HIV. For skin problems, the B-6 should be only one part of a package that also includes zinc, Vitamin A, and essential fatty acids in order to obtain the best results.

DATA: B-6 has been found to be deficient in many people with HIV, even in early disease stages. Dr. Marianna Baum's group of researchers at the University of Miami School of Medicine have even found such decreased levels of B-6 in asymptomatic people who were taking higher-than-normal doses of B-6, up to seven times the RDA. Their research showed a statistically significant association between B-6 status and several different immune parameters (serum immunoglobulin levels, NK cell toxicity, and immune cell subpopulations), leading them to conclude that this deficiency contributes to immune dysregulation in HIV disease. They found that giving B-6 to people during early disease stages actually results in CD4 cell increases. Their research also showed that B-6 deficiency does, indeed, result in depression, anxiety, and mood disorders in people living with HIV because of the need for B-6 in the proper metabolism and synthesis of neurotransmitters.

A test-tube study showed that the pyridoxal-5-phosphate form of B-6 could bind to white blood cells in a way that prevented HIV from infecting the cells. It had no effect on already infected cells. Since this was a test-tube study, we don't know if it might have this protective effect in humans, but it is certainly an interesting possibility that should be studied.

SOURCES: The richest dietary sources of B-6 are: organ meats such as beef liver and kidney, wheat germ, bananas, fish (especially salmon, mackerel, halibut, and tuna), poultry (especially white meat), sunflower seeds, egg yolk, broccoli, dried beans (especially lentils and soybeans), brewer's yeast, walnuts, filberts (hazelnuts), whole grains, especially whole wheat and buckwheat, peanuts, prunes, potatoes, cauliflower, cabbage, tomatoes, and avocados.
NAME: Vitamin B-12 and Folic Acid

Vitamin B12 (cobalamin), known to be deficient in a large percentage of people with HIV, plays many critical roles in the body.

Vitamin B12 is necessary for the production of red blood cells, the regeneration of nucleic acid and bone marrow and, with the other B vitamins, the conversion of fats, carbohydrates, and proteins to energy. B-12 is also essential in humans for the healthy metabolism of nerve tissue.

B-12's partner in many body functions is folate (often referred to as folic acid, the form found in supplements). Folate is required for the synthesis of DNA and other important metabolic processes, for making red blood cells, and for proper neurological function.

B12 and folic acid are critical to prevent or eliminate the often-overwhelming fatigue that so often accompanies HIV disease, as well as to help prevent some forms of neuropathy and brain and spinal cord changes. Maintaining adequate B12 levels also supports the bone marrow’s production of blood cells (crucial to prevent white and red blood cell decreases), and helps protect the heart.

There are countless anecdotal reports from people with HIV that using B-12 supplementation has dramatically improved their lives by its ability to reverse fatigue, often restoring normal energy to people who had previously been so exhausted that their daily functioning had been greatly affected. Many people have also reported significant improvements in memory and mental functioning, improvements that have made a huge difference in daily life. The possibility that B-12 supplementation might also help prevent or reverse the spinal cord changes that can have such devastating effects on some people is also very encouraging.

B-12 and folic acid should always be given together since taking folic acid alone could prevent the blood cell changes that might otherwise indicate B-12 deficiency. Doses of B-12 (1000 mcg given daily via pills, or one to several times weekly via prescribable nasal gel or injections) and folic acid (800 mcg daily via pills) may be useful for restoring energy, treating neuropathy, protecting the heart, increasing overall feelings of well being, and boosting mental function (especially when combined with thiamin, niacin, and folic acid since all four of these B vitamins are needed for normal thinking) even when tests don’t indicate obvious deficiencies. The injections or nasal gel forms of B-12 bypass absorption problems that may be present in many people with HIV due to problems with the parietal cells, which produce the intrinsic factor that is needed for absorption of B-12 consumed orally.

B12 deficiencies are known to cause nervous disorders, brain damage, and anemia, and HIV disease progression. Deficiencies of B-12 can result in deterioration of mental function and neurologic damage that will yield such symptoms as memory loss, decreased reflexes, weakness, fatigue, disorientation, impaired pain perception, tinnitus (chronic ringing in the ears), neuropathy, burning tongue, and various psychiatric disorders. B-12 deficiency can also cause canker sores in the mouth, impaired bone marrow function, loss of appetite, and loss of weight, as well as impaired antibody responses to vaccines.

Folic acid deficiency can also cause fatigue and weakness, along with irritability, cramps, anemia, nausea, loss of appetite, diarrhea, hair loss, mouth and tongue pain, and neurological problems. In addition, folic acid deficiency is believed to play a role in the development of numerous and varied types of human cancers.

A combination of B-12 and folic acid deficiency can allow increases in blood levels of homocysteine, a chemical that can damage artery walls and contribute to heart disease (although even with these deficiencies, the increases may not always be present in all people with HIV; see below).

One of the known causes of B12 deficiency is chronic viral illness with resulting poor gastrointestinal absorption. AZT use may contribute to deficiencies of both B-12 and folic acid. Many other drugs may worsen folate status in the body including TMP/SMX (Bactrim, Septra), pyrimethamine, and methotrexate (all three of which are folate antagonists), as well as phenytoin (Dilantin), various barbiturates, and alcohol (all of which block folate absorption). B-12 deficiency can also worsen folate levels in the body because B-12 is required to change folate into its active form.


HIV studies by researchers at the National Institutes of Health, the Pasteur Institute, and the University of Miami School of Medicine have all clearly shown that B-12 is deficient in many, and that the deficiency can begin very early, even in completely asymptomatic stages of the disease. One study found subnormal or low levels of B-12 in 143 out of 150 people with HIV (95%) treated at a clinic. Folic acid deficiency has also been shown to be present in many people living with HIV and research has made it clear that blood folate levels do not reflect tissue levels. Using serum or red blood cell measurements of folate has been shown to not accurately reflect the folate levels in cells.

In addition, researchers have shown that it is possible that B-12 may inhibit HIV infection of both monocytes and lymphocytes. Duke University researchers looking at this possibility have noted that several forms of B-12 inhibit such infection and have suggested that these forms should be considered as potentially useful agents for anti-HIV treatment. Of the forms found by the researchers to be inhibitory of HIV, the most commonly available is hydroxocobalamin.

B-12 may play a very critical role in preventing HIV disease progression: A large Johns Hopkins University study found that people with HIV who are deficient in B-12 have a two-fold increased risk of progression to AIDS. In this study, those who were B-12 deficient progressed to AIDS four years faster than those who were not. The exact mechanism by which adequate B-12 in the body may slow progression is not known, but the finding is not surprising to those who are familiar with all the roles B-12 plays in healthy human function.

It is important to remember that standard blood tests do not always accurately reveal B-12 deficiencies. Researchers point out that B-12 deficiency is present in a large percentage of people with HIV, but does not always cause the red blood cell changes that physicians look for as a sign of deficiency. In addition, because the standard blood test reflects only what’s in the bloodstream and not what is in the body’s cells, a reading that appears normal may not truly reflect the body’s status.

Neurologists who have studied this often recommend simply supplementing with B-12 when any of the symptoms that could indicate a deficiency are present. This would include neuropathy, fatigue, and memory loss. [Note that although those who are more sophisticated in the use of appropriate tests for nutrient status often use plasma homocysteine as a measure of B-12 deficiency (since it normally rises with a deficiency), it may not be useful for many people with HIV because homocysteine is a thiol compound. Because of the oxidative stress that HIV induces, it appears that thiol compounds are being rapidly oxidized in a large percetntage of people with HIV and are, thus, not always available to create homocysteine. Thus, even with substantial B-12 deficiency the homocysteine level may not rise.]

SOURCES: The richest dietary sources of B-12 are organ meats such as liver, heart, and kidney, other red meats, fish (especially the oily fish such as tuna, trout, herring, mackerel, etc.), egg yolks, milk products, especially yogurt, and chicken.

Note for Vegetarians: Vitamin B-12 is of special interest to vegetarians since it is not found in any significant amounts in plant foods. Many vegetable or bean foods that were once thought to supply B-12 (including fermented tempeh, miso, and various seaweeds) have been shown not to contain the form of the vitamin needed and, thus, strict vegans (those who eat no animal products at all) will definitely need B-12 supplementation. More about vegetarians and B-12...

The best dietary sources of folic acid are the green, leafy vegetables, including spinach, kale, beet greens, chard, asparagus, and broccoli, along with liver, kidney, brewer's yeast, Brussels sprouts, bean sprouts, wheat germ, soy flour, corn, lima beans, green peas, sweet potatoes, parsnips, black-eyed peas, and many fruits and fruit juices, including oranges and orange juice, cantaloupes, pineapples, bananas, loganberries, strawberries, and boysenberries.

Methyl B-12 (Jarrow); 100 lozenges / 1000mcg methylcobalamin ea. Suggested usage: dissolve under tongue or chew one 1000 mcg lozenge every 2 or 3 days with a meal.
Methylcobalamin (Methyl B-12) is better absorbed and retained than other forms of B12 (such as cyanocobalamin). Methyl B12 protects nerve tissue and brain cells and promotes healthy sleep. Methyl B12 is a cofactor of methionine sythase, which reduces toxic homocysteine to the essential amino acid methionine. Methylcobalamin also protects eye function against toxicity caused by excess glutamate.
NAME: Biotin
DESCRIPTION: Biotin is a water-soluble B vitamin that is normally produced in the intestines by bacteria.
FUNCTION: Biotin is needed for proper metabolism of proteins, carbohydrates, and fats. It is essential for healthy hair, skin and muscle tissue.

Without biotin, you can't synthesize fatty acids or properly use fat in the body, so supplementation may be very crucial to help maintain the body's ability to use fat for its major energy source, rather than protein.

In people with HIV with wasting, there appears to be an abnormal switch to burning up protein stores (the muscles and other lean tissue). Biotin deficiency could contribute to this, and also causes impaired metabolism of the branched chain amino acids (valine, isoleucine, and leucine).

The most common symptoms of biotin deficiency include: dry, flaky skin, rashes around the mouth and nose, muscle pain, nausea, anemia, and hair loss that can ultimately result in baldness. If you have any of these symptoms, it might be wise to increase your daily level of biotin to see if this will help.

DATA: It has been suggested that the success seen treating diabetic peripheral neuropathy with biotin might have some crossover to HIV-induced neuropathy.
SOURCES: While Biotin can be obtained from food, the main food sources (nuts, whole grains, milk, vegetables, organ meats like liver, egg yolks, and brewer's yeast) have only small amounts of biotin, and these foods may be scarce in some people's diets, especially those on low-fat or dairy-free diets.
CAUTIONS: If you have taken various rounds of antibiotics for past infections or if you are taking long-term antibiotics, such as the prophylactics used to prevent various infections like PCP, you may have destroyed most of the bacteria that would normally produce most of the biotin for the body, increasing the chance that you may be Biotin-deficient.
DISCLAIMER: These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.