Being Alive 1993 Nov 5: 17
The business of nutrition starts at the grocery store and ends in the
toilet. Everything that happens in-between is the specialty of
nutritionists. Since shit still happens, and diarrhea is still a major
problem in HIV/AIDS, I'll re-state some of the therapies nutrition can
offer for the "Big-D."
However, diarrhea isn't the only problem of elimination; its opposite,
constipation, is also among us and can be easily corrected using
elegantly simple dietary strategies. A third problem with elimination
is vomiting not always easily controlled with nutrition power, but you
might be surprised... And, last, a nutrition problem no one is talking
about, "sweats," because it's not usually seen as a nutritional item
let me assure you, it is!
These two bowel malfunctions share the same nutritional remedy Fiber!
Surprised? It's like this: Fiber comes in two forms, insoluble and
soluble, and knowing about each of them is the key to nutritional
control of diarrhea/constipation.
Insoluble: The first, insoluble type of fiber we normally think of, is
true "roughage" and looks sort of "fibrous." Its major sources include
fruits (peel especially), vegetables, and wheat-based whole-grains.
Legumes (beans, peas, lentils) have insoluble fiber in the husks.
Melon caution: higher insoluble fiber levels than you might think!
The function of insoluble fiber is to "bulk and hydrate the stool."
The effect in HIV/AIDS is often to overhydrate, causing runny bathroom
events. It's possible that our intestines' way of attacking an invader
like crypto or salmonella may be to dilute bowel contents in order to
rid itself of the bug. So, in HIV/AIDS, there could be two distinct
and highly effective ways of causing diarrhea.
For parasites, medical diagnosis and treatment is recommended (good),
but not always successful (not good). At least we can control the
roughage (very good!). Avoid fruits, vegetables and whole grains when
you have diarrhea.
Soluble fiber tends to have the opposite effect of insoluble; it slows
the intestines, creating a smoother-acting colon. Since soluble fiber
isn't very well known (and highly underappreciated), I'll describe it
briefly. Think of oatmeal; once you get it onto your spoon, it's
unlikely to slip off or shake off. Actually, it's also hard to eat
off. Imagine what that kind of food does in your intestines, and now
you have an idea of how soluble fiber works to ease diarrhea.
Don't stop at oatmeal! Oat bran works just as well, and it tastes kind
of like cream of wheat, so a beneficial swap is indicated here. Also,
soluble fibers are found in bananas, apples (skinless), white rice and
barley. If you can make these grains into your staple starches, you'll
be doing incredible bowel control in your kitchen. Pasta and potatoes
(skinless) are also very useful.
Rice is one of our most powerful do-it-yourself diarrhea remedies. See
the box for a few ways to use rice and barley. The "rice mush" recipe
is for diarrhea. Stir rice mush into soups, gravies, stews and hot
cereals. If you make protein shakes, add a cup of rice mush to the
shake. That makes it a medically important drink, far beyond its
nutritional value of giving you protein and calories it allows you to
Still, there is Ricelyte a recommendation from last March. This
"pediatric" product reduces diarrhea volume and replaces lost fluids
and electrolytes. It has rice syrup solids (note benefits of rice) in
addition a powerful-acting agent.
There were problems with my Ricelyte recommendation last March. First,
the product was hard to locate. As of now, all of the Aid for AIDS
pharmacies carry it. These include Care-Rite in Pasadena, West
Hollywood Pharmacy, Vee's Pharmacy and Capitol Drugs in West Hollywood
and Ad Rx Pharmacy, Discount Medical Pharmacy, Px Drugs and Bob's
Pharmacy. These folks have been told that this article is going to
press. They're ready and able to provide for your Ricelyte needs.
The other problem was taste. While the "mixed berry" flavor isn't bad,
it gets boring fast with everyday use; thus Ricelyte's flavor needs to
be altered from time to time. I suggest using flavoring agents like
Tang, Kool Aid, Crystal Lite and even jello to re-arrange Ricelyte's
taste. Ricelyte works use it.
Constipation is the flip-side of diarrhea. It can even be a problem
for the same person, on the same day, by altering or cycling on and
off. This is the classic case where tight fiber-management is
warranted. Anti-diarrheal agents can create a "plug-effect" that feeds
this type of cycle. Using nutrition power, you may no longer need
Constipation can be just as serious a problem as diarrhea, but is seen
less frequently in HIV/AIDS. Constipation can have and cause side
effects like painful hemorrhoids and diverticulosis, and it can
aggravate a diseased colon (colitis).
To keep a smooth-running system, pull in your nutritional powers using
insoluble fibers like wheat germ, high-fiber cereals and grains, and
lots of fruits and vegetables. (Don't do all of the above at one time
you could bring on a diarrhea cycle.)
These two disturbances are lumped together because usually, if we can
control nausea we automatically eliminate the vomiting. When vomiting
occurs, it's often a very unpleasant "reward" for eating well. We're
talking sub-conscious thought. The association between food and
vomiting can become a major psychological barrier.
To prevent nausea, first stay away from odors avoid the smell of food
especially. Avoiding aromas can prevent nearly all nausea attacks.
Since warm and hot foods emit odors, try to eat food cold or at room
temperature. If you can remove yourself from odor sources (like the
kitchen during cooking), you're more likely to completely control
vomiting related to nausea.
If you get a hot meal from Project Angel Food (or other service), have
the delivery angel put your meal in the fridge for you to eat later
they understand things like that. If a caregiver is cooking for you,
stay away from the kitchen during the cooking event and stay away till
the aromas are gone. Eat the food cold.
Yes, it's actually OK to eat cold spaghetti, pizza, steaks and
hamburgers. (Be sure foods are stored in the refrigerator not at room
temperature.) Cold foods don't taste quite like their warmer
counterparts (you can't have everything!), but they don't create
nausea like those counterparts either.
Some foods are good at quieting nausea. Pregnant women with morning
sickness do it all the time: saltines, bouillon, broth, chicken soup,
etc. All of these foods are bland, salty and very effective.
It's also wise to avoid hot spices, caffeine and your favorite food
when nauseated. Yes. Don't allow your brain to get the idea that you
have nausea associated with your favorite food. Save that food for use
when your appetite is down; don't create a subconscious food-aversion.
Use of anti-emetics (anti-nausea medication) is useful. As most are
aware, Marinol, an appetite stimulant used for HIV/AIDS, is a potent
anti-emetic too (as is the case with it's illegal cousin, marijuana,
I'm told). Most HIV-docs seem willing to prescribe this for appetite,
so you might want to check it out for problems with nausea as well.
With diarrhea, constipation, and vomiting, fluids are important.
Doctors and nurses estimate that from one quarter to one half of all
HIV/AIDS hospital admissions are for dehydration. The last thing any
of us needs is an unplanned vacation in the hospital for a completely
Many HIV-related symptoms involve massive perspiration or sweats.
Often, night sweats cause incredible fluid losses, but when you're in
the middle of such a miserable experience, the very last thing on your
mind is food and nutrition. But, from now on, please remember that you
have an urgent need, at that time, for avid re-hydration. Whatever is
liquid will do.
With massive fluid losses each day, you may need electrolytes as well.
Beyond plain liquids, replacing electrolytes can be done with
Ricelyte, Gator drinks, fruit juices and nectars, and
broth/bouillon-type fluids. Even 7-Up, Ginger Ale and other sodas work
well. Ricelyte, as mentioned, has both fluid and electrolytes.
But if wish, you can make your own rice water/rice mush and use it
with any fruit nectar or Gator-type drink from the store. It's an
economical runner-up to or alternate beverage compared to Ricelyte.
As to how much one needs to drink each day, the amount necessary will
vary with each individual's "output profile" for the day. For example,
a day of reasonably quiet bowels, no fevers or sweats, no vomiting
that's the day to use as "baseline," or "normal." It calls for your
"normal" 2-quart/day schedule. On days of losses from diarrhea,
vomiting or sweats, fluid needs could be more than double that of
The very important thing to remember here is that avoiding dehydration
is like avoiding opportunist infections. It's one that's really easy,
because it's avoidable with attention and care, but it's
life-threatening if unattended.
Prophylaxis against vomiting and diarrhea could also prevent a major
causes of HIV/AIDS-related weight loss not retaining food/calories.
The medical equivalent might be prophylaxis for PCP.
The Last Word
My professional "bottom line" on eliminating the problems of
elimination is control. We all have it, not all of us know how or when
to use it, but it's there. Remember Nutrition Power awesome!
Naturally, if following the advice in this or any other column on
nutrition and HIV/AIDS is or seems to be related to adverse symptoms
or consequences, seek appropriate medical/nutritional help from a
(Jennifer Jensen, MS, RD, has a private practice in Santa Monica. She
offers a sliding scale for HIV. She welcomes your call at