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Naturopathic Medical Interventions in Persons Living With HIV
- Dr. Aaron Hoo, ND

June 15, 2011 - The use of natural medicines in the management of HIV extends over thirty years. Indeed, persons living with HIV and AIDS turned to herbal preparations even before the appearance of anti-retroviral drugs. The following article provides an insight into some of the time-tested herbs for the purpose of supporting the immune system and managing the complications of anti-retroviral drug regimens.

Naturopathic medicine is steeped in traditional and empirical information; in light of this however, there's an increasing number of clinical trials and research being performed on various herbs, its extracts as well as nutritional supplementations ranging from fish oils to probiotic formulations. Medical journal search engines provide a large cachet of research material on complementary and alternative medicines, so much so that the old criticism of there being insufficient data to support the claims of NHPs is no longer valid.

Naturopathic doctors (NDs) may choose to treat the whole person using acupuncture, herbs (Western, Ayurvedic or Chinese), clinical nutrition, homeopathy, physical medicine (eg. ultrasound, infrared light), hydrotherapy and lifestyle counselling.

These treatment modalities are always applied with the following naturopathic principles in mind:
- First do no Harm (using gentle, non-invasive means to enhance the healing process)
- Identify and Treat the Cause (treat the cause of physiological imbalance and dis-ease)
- the Healing Power of Nature (using natural medicines to aid the body in healing itself)
- Treat the Whole Person (address mental, physical, spiritual & environmental factors)
- Prevention (focus on prevention to promote health and wellness)

This article will focus on the use of herbal preparations for the purpose of supporting the immune system in persons living with HIV/AIDS. In the interest of avoiding possible herb-drug interactions, it is essential that you consult your primary healthcare provider (MD or ND) before you begin taking any of these herbs for medicinal purposes.

Garlic is a common herb used in everyday cooking; it is beneficial as an antiparasitic, antifungal and antibacterial agent; it has also been shown to lower blood pressure as well as total cholesterol and triglycerides with an overall benefit to the cardiovascular system. It is advised that one avoids taking more than the equivalent of ten cloves daily as this doing so may decrease the plasma levels of saquinavir (Invirase). (7) Additionally, ingesting large amounts of raw garlic may not only cause an upset stomach but can also potentiate anticoagulant medications resulting in prolonged bleeding. According to traditional Chinese medicine principles, garlic should not be taken if signs of heat are present. (2)(3)

Astragalus is a wonderful herb used in traditional Chinese medicine and classified as an overall tonic, adaptogen, cardiotonic, hypotensive and an antioxidant. It has been shown to strengthen the immune system and combat viral infections by increasing white blood cell counts and is therefore used to reverse low white blood cell counts (leucopenia) as a result of chemotherapy. Astragalus is also used to treat night sweats, fatigue and debility. This herb should be avoided when taking immunosuppressive drugs (eg. for an autoimmune condition) as well as in acute infection as it may strengthen the pathogen. (2)(3)

Medicinal mushrooms like maitake, shiitake and reishi have a long history of supporting the immune system and supporting individuals during chronic illness and stress. They are classified as immuno-modulators (meaning balancing the immune system) and are potent antiviral agents (5) with anti-cancer properties due to their polysaccharide and beta-glucan fragments; (6)(9) of particular interest are two chemicals found in shiitake known as Lentinula edodes mycelium extract (LEM) and lentinan which directly increases immune function. Some studies have also identified shiitake's LEM as being potent inhibitors of HIV viral replication (4). These mushrooms should be avoided if you have a known mushroom allergy, or have an active yeast or fungal infection. Medicinal mushrooms may also cause upset stomach or diarrhea if taken in excessive doses.

Ashwaganda is an Ayurvedic herb that is classified as an anti-inflammatory and adaptogenic with the ability to calm and strengthen the nervous system. As such, it is typically used to support individuals' ability to cope with illness and stress as well as improve sleep. Ayurvedic doctors traditionally use ashwaganda to treat muscle wasting and weight loss in men with low testosterone; by extension, ashwaganda is prescribed to rejuvenate the immune system in people living with HIV. At the Nizam Institute of Medical Sciences in Hyderabad, India, a small trial involving 36 HIV infected persons revealed ashwaganda's ability to improve symptoms, decrease viral load and increase CD4 values; while this is promising, more research is required to fully understand the mechanism of actions of this herb in HIV management.

Licorice is an excellent adaptogenic herb with antiviral and anti-inflammatory properties (potentiates the anti-inflammatory effects of glucocorticoids) as well as being soothing for mucous membranes. Earlier studies revealed licorice's ability to retard disease progression in HIV while improving T-cell counts. In traditional Chinese medicine, this herb tonifies the spleen meridian which benefits the vital force (Qi), moisten the lungs and stops coughing. It also clears heat and is soothing in cases of respiratory spasms. This herb may elevate blood pressure if taken over a long period of time (it retains sodium, reabsorption of water and excretion of potassium) and should be avoided in cases of hypokalemia (low potassium levels), edema or congestive heart failure. Additional caution should be taken if you are on digoxin, diuretics (eg. thiazides) or laxative drugs. (2)(3)

Echinaceae is a wonderful immune-modulator and anti-inflammatory; it is known to enhance one's resistance to infections (especially of the upper respiratory tract) while aiding in the recovery from chemotherapy. Topical applications may also be used to reduce inflammation. Traditionally, this herb was used to treat bacterial, viral and protozal infections of the digestive, respiratory and urinary tracts. Echnicacea can be especially helpful in sinusitis and recurrent candidiasis often seen in HIV. (8) It is important to note that herbalists and NDs typically use the alkylamides in roots of this herb (especially Echinaceae angustifolia) instead of the flowering tops which contain polysaccharides. This is a point of contention since some authors suggest that long term intake of Echinaceae's polysaccharides activates CD4 cells, allowing for more "target cells" for HIV to infect. It should be noted that the original studies propagating this concern were performed with intravenous infusion of the herb (versus oral intake), the latter of which would ultimately disintegrate the active polysaccharide components (as would herbal tincture extract of Echinacea in 60% alcohol suspension) making the pt moot.(1)

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References:
1. Bone K. Echinaceae: What Makes it Work? Alt Med Rev 1997;2 (2):87-93
2. Chinese Herbal Medicine “Formulas and Strategies”, Bensky and Barolet. 1990 Eastland Press
3. Chinese Herbal Patent Medicine, Jake Paul Fratkin. 2001 Shya Publications
4. Collins RA, Ng TB (1997). "Polysaccharopeptide from Coriolus versicolor has potential for use against human immunodeficiency virus type 1 infection". Life Sciences. 60 (25): PL383–7
5. Li Y, Yang Y, Fang L, Zhang Z, Jin J, Zhang K (2006). "Anti-hepatitis activities in the broth of Ganoderma lucidum supplemented with a Chinese herbal medicine". The American Journal of Chinese Medicine. 34 (2): 341–9
6. Lin ZB, Zhang HN (November 2004). "Anti-tumor and immunoregulatory activities of Ganoderma lucidum and its possible mechanisms". Acta Pharmacologica Sinica 25 (11): 1387–95.
7. NHP-ARV drug interaction review: Mills, Montori, et al.; Int’l J of STD & AIDS 2005; 16:181-186
8. Principles and Practice of Phytotherapy (Modern Herbal Medicine), Simon Mill and Kerry Bone, 2000 Churchill Livingstone
9. Yuen JW, Gohel MD (2005). "Anticancer effects of Ganoderma lucidum: a review of scientific evidence". Nutrition and Cancer. 53 (1): 11–7.

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Dr. Aaron Christopher Hoo - Naturopathic Doctor & Medical Director
Dr. Aaron Christopher Hoo graduated from the Canadian College of Naturopathic Medicine in Toronto. Prior to this, he completed his Bachelor of Science degree in Psychology at the University of British Columbia. Dr. Hoo is currently the medical director of an integrated medical clinic in downtown Vancouver and travels across North America as a keynote speaker, educating doctors on functional medicine. In addition, he is a sessional clinical supervisor at the Boucher Institute of Naturopathic Medicine facilitating the first off-site naturopathic clinic at Vancouver's Friends for Life Society. Dr. Hoo is the past contributing writer with the Canadian Disability Magazine and board member with the Canadian Association of Naturopathic Medicine as well as the British Columbia Naturopathic Association. In his spare time, he maintains a balance of spirituality and wellness through regular exercise, yoga and meditation.
www.draaronhoo.meta-ehealth.com

 

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