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Being Alive

Disaster Nutrition




 

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 gender notwithstanding).

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.

About Water 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 diarrhea.

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 water-borne OIs.

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 prevent! 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 equipment.

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 spas.

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 the Alps.

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, bare-bones nutrition.

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 "nutrition negligence." So, disaster nutrition can be summed up as follows: - Keep adequate food, emergency equipment, water and utensils on hand for disasters/surprises.

- 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.)



 




Information in this article was accurate in February 5, 1994. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.