Being Alive 1994 Feb 5: 15
In the wake of the quake, it's only fitting that a new way of thinking
about what we eat and what we drink should be considered. I call it
"disaster nutrition," but it could just as well be called "surprise
nutrition" disasters are usually surprises.
Since food and water truly are necessary for life, planning for them
in the face of pending disasters makes a lot of sense - don't forget
the floods, the fires, the riots and the hurricanes, not to mention
tornados and other devastations. Practicing disaster nutrition is
totally simple: Be Prepared. Just like a good boy scout (age and
To be completely prepared for disasters, we should keep extra canned
food, a can opener, and a spoon or fork along with flashlights, radios
and batteries like always, right? Add now an unbreakable glass to
drink from and enough water: 2-3 gallons per person.
I've mentioned the water safety issue before in this Newsletter and it
cannot be overemphasized. My advice is to drink only distilled or
boiled water. If you've read prior warnings without a sense of urgency
or personal concern, it's time to re-think the issue and operate with
a new attitude about safety, opportunistic infections, and intractable
Risky uses of water include drinking, teeth-brushing, ice, and soda
fountains (in movie theaters and many restaurants) which mix tap water
with syrup. Even filtered water is not pure enough to be safe from
After the quake, newscasters were quick to point out that the murky
tap water in Los Angeles was unhealthful. And they did a pretty good
job of advising that residents drink only bottled/boiled water or use
bleach to purify the dirty water. It's true that bleach is pretty
strong stuff, but it just doesn't work well enough as a water purifier
for HIV/AIDS. Again: distilled or boiled water only.
Remember that crypto- and micro-sporidia can live perfectly well in
bleach and iodine. MAI may also survive these chemicals. In any case,
all three are diarrhea-causing, AIDS-defining opportunistic infections
that are transmitted through water. So, all three are probably
preventable by behavior that is appropriately neurotic about water
safety. Think of it as prophylaxis all OIs should be so easy to
To boil water correctly, keep it rolling for 20 minutes; cover the
container to prevent losing water from steam. Distilled water, in
fact, is captured steam, but our kitchens don't have distilling
At Project Angel Food, we sent out water advisories with my
guidelines, and all 450 clients were invited to call me for further
clarification. I heard from a lot of people, and the most prevalent
question was "How long do I have to keep doing this?" My answer:
"Don't stop at all, you should have been doing it anyway." This,
again, is prophylaxis of major diarrheal opportunistic infections.
About food/water safety, I often say: "Don't gamble if you can't
afford to lose."
Another common question is about bottled water from fresh springs or
Let's think... Picture in your mind the lovely scene of the Swiss
Alps. Some companies which provide bottled water may give us the
impression from pictures on their labels that the water is fresh from
Can we talk? Do you really believe that a water-carrying truck goes
way up high to the tip tops of the Alps, fills up with water, carries
it across Europe, delivers the water to a boat which then takes it
across the Atlantic Ocean to the shores of the US eastern seaboard
where it is loaded to another truck, then is taken across the
continent to be delivered directly to your LA-area supermarket shelf?
Even if all this were true, it would probably be very expensive and
also somewhat old by the time we buy it. Are the Alps a safe water
source? Is there a possibility of contamination during transit? Good
questions to ponder.
Designer water bottles are great; they have a very clean and fresh
look. If that's important to you, boil the Alps-water and put it back
into the Alps-bottle. Truly an inspired idea for those who want to
maintain that "mysterious" European aura!
The Stress Mess
Safety about food and water is surely one of our most important
concerns, but it can get boring. If food and water safety doesn't
excite you, think about how stressful it is to be sick. In fact,
post-traumatic earthquake syndrome includes, along with fear, plenty
of emotional stress as well, which can depress immunity. And this
issue actually (believe it or not!) takes us right back to basic,
First, the stress we tend to feel places most of us in a hormone
imbalance. The way it works is that we make lots of adrenaline, a
stress hormone, even if we're not aware of this shift to the "stress
response." Where it impacts upon nutrition is when it changes appetite
and alters our food choices. Usually we're not conscious of this.
About appetite: Personally, I've been absolutely ravenous since the
quake, where normally my appetite isn't all that huge. Yet, during the
aftermath and constant nibbling, I've continued to lose weight though
I've been eating much more than usual. Adrenaline speeds up our
metabolic rate; we burn calories more easily and thus may need to eat
more during stressful situations, like the quake's thousands of
aftershocks always fearful of The Big One.
Stress can also depress appetite. It's related to the "fight or
flight" syndrome. During that urgent situation, eating isn't our most
prevalent concern so nature and stress hormones remove hunger signals
and appetite. That's where it gets risky. Unintentional weight loss,
for any reason, is cause for concern and the notion of "that's just
because of the earthquake" is not an acceptable reason. Reasons are
actually excuses, and weight loss from an underactive appetite is a
"no excuses" situation.
We need to take the precaution of noticing how much food we're
consuming and being sure to maintain adequate intake. The best way to
handle loss of appetite, even when it's totally gone, is drinking
(which is possible even with a sub-zero appetite). This is where
liquid-meal-in-a-can products can be useful. Alternatively, more of
your favorite protein shake may help. The more we consume, the added
stress of inadequate appetite is removed, and the situation of poor
appetite will be remedied more quickly.
My advice is to use your own personal means of dealing with the
emotional stress (we all should have a stress-reduction program; if
you don't, now's a good time to start one), and handle any appetite
losses using your favorite foods and liquid meals as needed. The more
we eat, the better our appetite will be, and importantly, we avoid
So, disaster nutrition can be summed up as follows:
- Keep adequate food, emergency equipment, water and utensils on hand
- Never, no matter how healthy you are, drink questionable water or
other fluids. Beverages like coffee and tea are safe because the
hot water that makes them is boiled-thus-safe.
- Take note of weight and appetite. If it's not sufficient, take
action such as those already suggested.
- Don't get sick from being sloppy about food/water safety.
- Use stress reduction/management strategies.
- When in doubt, don't!
Naturally, should any of the advice in this article be, or seem to be,
connected with adverse consequences, discontinue and see your
nutritionist or physician at once.
(Jennifer Jensen, MS, RD, is in private practice and offers a sliding
scale for HIV/AIDS. She welcomes your call at 310.450.5581.)