Being Alive 1994 Mar 5: 12
(This article is about suitable nutrition principles for most people
with HIV/AIDS. If you are in doubt, consult with your physician or
Studies confirm that when living with HIV/AIDS, those who change their
diets use guidelines for prevention of other diseases like heart
disease and cancer. Don't misunderstand prevention of these maladies
is very important. But, with HIV/AIDS, there is little risk of either,
except for immune-related Kaposi's sarcoma (KS) and lymphomas.
Another fascinating fact: Heart-healthy aerobic exercise, while
important for everyone's health program, is not to be overdone; it's
important to emphasize muscle-building exercises like lifting weights
and other resistance work.
So, when deciding how to conduct our nutritional selves, we'll read
advice in magazines and newspapers, see it on TV, hear it on radio,
and overhear gossip. Do you think these communications are targeted to
HIV+ America? No way!
What everyone reads and hears about is diet advice for middle-class,
"Norman Rockwell" America. We hear that a diet high in saturated fat,
for example, is bad because it raises blood cholesterol. The HIV/AIDS
counterpoint is that some saturated fat such as medium-chain
triglycerides (MCT) can be the perfect fat type for us and MCT is
totally saturated! Coconuts are full of MCT; in fact, their milk and
flesh are almost all fat and it's 97% saturated! A heart patient could
have a coronary just looking at coconuts!
Remember, 249 of 250 Americans are HIV negative. The only place you'll
get HIV-specific and current nutrition advice is from newsletters like
this (a book would be outdated before it ever got to press). And
that's why I call this "upside-down." Take what you read in the
"popular press," and almost always do the opposite from diet to
I keep indulging in "salad bashing" it's so easy! Take the common
leafy salad. For the 249 out of 250 people who may need (or want) to
lose weight, salad is a perfect food. It has no significant nutrient
value, almost no calories, and with low or non-fat dressing, it's
really just a "flavor carrier." That salad has very few calories and
takes a long time to eat. Also salads contain "roughage" for promoting
easier, quicker bowel movements. Upside-down!
There's still that one in 250 who generally doesn't need or want to
lose weight. You've heard of "empty calories"; salads are "empty
foods." Lettuce (including Romaine) has almost no nutrients. It gets
worse. Lettuce packs in water, holding the fluid between its plant
cell walls. This watery appetizer, which gets squashed when you chew,
can contribute to the "feeling-full-too-fast" syndrome. And those
plant cells are pure roughage; enough to make a bad case of diarrhea
worse, and cause a good case of diarrhea for those lucky enough not to
have it. Also, since salads do take time to eat, energy could be
wasted doing unnecessary work. Good for the majority, not good for
those of us who are not constipated! Upside-down.
But there's an even more important, and probably less well recognized
problem with salads: Hard-to-clean salad greens! (Ms. Food Safety
strikes again!) No matter what you do, or how hard you try, you're not
going to get those greens totally clean. Healthy immune systems are
fine with a little dirt; unhealthy ones are at risk. And for eating
out, perhaps a machine washed the lettuce well, but servers handling
the lettuce may only wear those cute little plastic gloves when in
public; behind the scenes, who knows? Worse yet, have you ever been to
a salad bar where there's a plate of glass to shield the buffet from
your breath they're called "sneeze-guards" for a reason!
Where's the Beef?
Salads gone, let's take on "the beef"! There are some outstanding
nutritional benefits in the meat group, red meat in particular for
HIV/AIDS nutrition health care. The heart-risk patient would be told
to eat less red meat and more white-meat chicken. That's exactly what
I would tell a normal HIV negative person with high cholesterol.
The reason that HIV negative America is told to eat less meat is
because of the fat and cholesterol. For this the no red-meat "rule"
was devised. But for HIV/AIDS, red meat is not only a good protein
provider, it's also a natural way to acquire iron, zinc, vitamin B-6.
In fact, even beef liver, really high in cholesterol, minerals and
B-vitamins, is very low in fat and another good food choice for the
And to settle a recent issue of mine: An HIV nutrition handbook warned
against all kinds of meat, pork in particular. While I have no quarrel
with Biblical law as practiced then, I must carefully point out that
pork is our very, very best source of vitamin B-1 (Thiamin), necessary
to digest carbohydrates. A recommended starch intake is about 60-70%
of all food eaten so this vitamin is important. Yes, it is available
in other foods, but it's awesome in pork.
Since those old pork rules had mainly to do with food safety, I'll
just grab another chance to warn everyone (regardless of HIV status)
to cook food well. Since heat kills germs, and modern refrigerators
prevent spoilage, all that is necessary to avoid food-borne infection
is to cook food very well-done, especially ground meats where every
morsel not just the surface as in a steak may carry deadly bacteria.
Just three words: Heat Kills Germs!
I also want to tackle, albeit briefly, the issue of animal protein
versus plant protein. Here are some facts from science. Protein is
made of strings of amino acids like uneven pearls. When protein pearls
are digested, they break down into individual amino acids (22 shapes
and sizes), which are sent to the liver and processed into living
cells. Amino acids are chemical compounds and are exactly the same
whether they come from an animal, a plant or (even) a test tube.
Then, there's the much-maligned egg. Long out of favor in US diets
because yolks are full of cholesterol (whites are cholesterol free),
eggs are invaluable for the diet geared toward the needs of HIV/AIDS.
Since egg yolk cholesterol is no longer bothersome, let's consider the
white: Pure protein, and the standard by which all other proteins are
judged. My advice: "Eat eggs" (well cooked, please!).
The Fiber Diet
Having dispensed with salads, red meat, liver, pork, protein sources
and egg conflicts, let's tackle just two more items in the Norman
Rockwell diet. How about fiber? Since the American public eats only
about 11 grams of fiber per day, but is advised to get from 30-40
grams/day (to prevent heart disease and some cancers), the high-fiber
diet is heavily promoted among health care professionals.
Sometimes, as with salads, that fiber may not be such a good idea, due
to diarrhea. But, remember, 249 out of 250 Americans want and need
more fiber they're constipated! Package labels are not only
informative, they're downright boastful on the fiber content. Avoid
these high-fiber foods if diarrhea is a concern. Here again, it's
upside-down on the advice for the public (increase fiber) as opposed
to advice for that special 1/250th person (decrease fiber).
One, Two, Three, Exercise
Now for exercise! Since HIV negative America generally wants to lose
weight, high-level aerobic exercise is recommended often multiple
workouts per day of panting/sweating exercise. For HIV+ America, the
minority, that kind of intensity may burn calories unnecessarily.
There's always a place for "some" aerobic work, but the major focus of
exercise for HIV/AIDS must be geared to resistance training
weight-lifting. Adding muscle seems to afford some protection from
wasting (a future article).
The HIV-infected body is different from others. Since weight loss is
usually more of a problem than a desire, unnecessary calorie burning
needs to be kept to a minimum, while adding muscles for that so-called
"lean mass" is emphasized. Thus, the weight training and muscle
building should be emphasized.
These exercise guidelines are very general because I am not, and never
will be, an exercise physiologist. How we spend our energy (calories)
is just as important as the kind of energy we take in (food). For
that, I suggest that the next step towards a maximum, "personal-best"
result: consult a fitness instructor or exercise physiologist for an
exercise plan. That is...after you have your nutrition in order!
(Jennifer Jensen, MS, RD, is in private practice, and serves as
nutritionist for Project Angel Food. She offers a sliding scale for
HIV/AIDS consultations. Don't be shy call her at 310.450.5581.)