Being Alive 1995 Apr 5: 12
Fat can be pretty hard to understand and manage when it comes
to living a good Nutrition Power lifestyle, Since fat is
loaded with calories, it can be a useful agent if you want to
gain weight. It can also hurt you if there's some liver
trouble, or if fat malabsorption makes you crampy, gassy, and
miserable. Also, fat is usually devoid of nutrients other
than plain calories.
But, fat's fun too; it carries flavor. That's why many of our
favorite foods contain lots of it. Flavors tend to be
fat-soluble so taste appeal makes us enjoy high fat foods. If
you don't believe me, look around you. There are a lot of
fine dining establishments like McDonalds and Wendy's that
generously serve up fat - high-fat foods are big sellers
because of that flavor thing. These wise business people know
that if you like what you eat there, you'll come back for
more. Staying away from this type of high-dose fat can be
really hard to do -- it tastes so good! Fats also confuse our
nutrition lifestyle. There's the question of what amount we
should eat, what type to eat, a breakdown of fat between good
fat, bad fat, and, of course, flabby body fat -- overhang
(called "love-handles" by our more sensitive friends) from
eating too much fat.
How Much Should You Weigh?
It depends. First, calculate your ideal body weight (IBW).
For men, use the 106-plus-six system: the first five feet of
height count for 106 pounds; add 6 more pounds for each extra
inch. For women, its the 105-plus-five system: 105 pounds for
the first five feet, then five pounds for each additional
Using "examples" from the audience: If you're "John" at 6
feet tall, you get 106 pounds for your first five feet of
height plus six pounds per inch thereafter. I did this math
for you: 106 plus 72 [6 x 12] gives an IBW of 178. The same
strategy is good for women: "Oprah," at 5' 7" needs 105 plus
35 [7 x 5], or 140 pounds for her IBW.
There's more-now calculate your Nutrition Power Recommended
Body Weight (RBW): Add from 10 to 20 pounds of extra
weight-for both men and women living with HIV/AIDS. John's
RBW range is 188-198, Oprah's is 150-160. Aren't calculators
Sometimes, high-calorie fat-eating gives us love handles and
other assorted bulges, when what we really need is strong
underlying muscle mass. So, what's necessary is that we wear
our extra weight as muscle - both men and women living with
HIV/AIDS. Consult a fitness trainer who's HIV- knowledgeable.
Another reason to go with the muscled, lean look is very
persuasive. The HIV-infected body uses muscle mass as a
"calorie reserve" versus uninfected people who use fat for
reserves. Building storage muscle now provides for any time
during which we don't eat regularly. We need to "hunk out"--
on the arms, legs, abdominal and other muscle groups (yes,
women too). I call it "muscle preserves."
Gaining weight doesn't mean you'll look fat! As it turns
out, since muscle is heavier and takes up much less space on
the body than fat, weighing more as muscle is the best thing
you can do for yourself. You don't have to be fat just
because you weigh more. I recently read in the very reliable
"National Enquirer" that Oprah, at 5' 7", weighs 150 pounds,
fits a perfect size 8. Since we know this is true (after all,
consider the source), we also know that Oprah works out daily
and is highly muscled. She's got 10 pounds of "our" RBW 10-20
pound muscle reserves -- and looks great! Men do have it
easier; they have more underlying muscle mass than women.
Sadly, we women have to work harder, but if Oprah can do it,
we can too!
With RBW in mind, let's talk daily calories -- more math, oh
my! For your own personal suggested calorie level, multiply
your RBW 10- and 20-additional pound range by 15. John's
ranges are 2570 to 2990 calories; Oprah's ranges are 2250 to
2400 calories. Exact precision is unnecessary here. It would
be too neurotic to count each and every calorie so that we
can be perfect every day, but we can look for weight trends,
a better indicator anyway. In case of malabsorption or
hypermetabolism, more calories are needed.
Fat Science, a Brief Tutorial
Researchers and other nutrition advisors call fat "lipids."
That's how liposuction got its name. This isn't really a
science course, but it's a good idea to understand and know
the lipid word now to make it possible for you to talk
science-speak; use it to impress your friends. Fat is
important for our health; every cell of our bodies is
surrounded by a fat-type linkage (bi-lipid membranes) which
protects it against unwanted entry, at the same time letting
oxygen and nutrients get inside. Also, fat travels through
our bloodstream--here they are called trigly-cerides. Fat is
linked to our blood-test specimens as "triglycerides." I
describe this as "pieces of fat floating in the
bloodstream"--instead of getting inside of cells where they
belong, making energy. This is probably a more familiar term
because they often show up high in blood tests. Eating or not
eating fat doesn't seem to make much difference in this
situation, but changing the type of fat can make a world of
difference. Read on
Sometimes, fat gets released from fat stores (cheeks, for
example), and is sent to the liver to be made into usable
energy-- which the liver can usually do. But sometimes things
can get messed up. Often, the liver's "home-made" fat
circulates in the bloodstream and is delivered into cells for
energy. To make energy, the fat needs a carrier called
Carnitine. Without carnitine, fat can't get into the
energy-making machinery of cells, so it gets sent back to the
liver for "re-modeling." It becomes a back-and-forth cycle.
Worse, each pass in the cycle is an energy drain; calories
are getting burned up just to feed the cycle. That's how
"futile cycling" (which can lead to wasting) got its
name--the body abusing the energy-making potential of fat by
sending it back and forth not making energy-- actually, quite
the opposite: an energy drain! This concludes the section on
body fat. Now, let's do diet-what you eat.
Ordinarily in our food plan there are two concerns about fat:
amount and type. From the top, how much fat to eat? This can
get kind of mathematical (which I am not), but stay with
me-you'll probably learn something useful. Researchers and
nutritionists often recommend a daily fat-eating limit of
"20-30% of total calories coming from fat." These
percentages can drive you nuts! I think it's easier to give
ourselves a fat "budget." This isn't a "rule," it's just a
Nutrition Power suggestion. For this, you need to know how
many calories you need. You need this "big picture"
information to find out your own personal fat budget; use
your RBW range.
Use the calculator one more time and multiply a few numbers
to get your Nutrition Power fat-gram ranges. John at his
lower RBW calorie number (2570) can get his fat-gram budget.
Just take 20% of the calories (2570 x .2 = 516) and that's
the fat calorie level. To make easier math, pretend that fat
has 10 calories per gram instead of the 9 calorie-per-gram
rule. That means John can have 516/10, or about 52 grams of
fat each day. For the upper RBW limit of calories (2990).
Twenty percent calories would call for 598 calories from fat,
so he'll need about 60 grams of fat (598/10). Oprah can
probably afford to pay a mathematician to calculate her
limits. Continue with this simple math for your own levels.
Calculators are really cheap - no home should be without one!
About Fat Type
Fat comes in various forms. The more familiar ones are
saturated (called bad fat), polyunsaturated (an immune
challenge), and monounsaturated (the most benign fat).
There's fish-oil fat, but that's another article. Suffice to
say that eating fish is good; taking fish pills probably
won't get you very far and they'll cost you money you could
spend more wisely. First, the most abundant: Polyunsaturated
Fatty Acids (PUFAs). These are in all vegetable oils, many
baked foods, and many recipes. Sources include sunflower,
safflower, soybean, cottonseed, corn, and peanut oils. These
are considered to be immune-suppressive because they are
easily oxidized (that means that they rot easily). They
should be stored in the refrigerator after opening, and
sniffed before using. If the sniff-test is thumbs-down, the
oil has probably been oxidized -- who wants to eat rotten
food? Second, the better oil, Monounsaturated Fatty Acids
(MUFAs), aren't easily oxidized, reducing rot risk, and
they're your best bet for fats. Unfortunately, the food
sources are limited. Sources are canola oil, olives and olive
oil, avocadoes, and macadamia nuts and oils. That's all. By
the way, no matter how light olive oil is, it still has the
same calories as, say, dark sesame oil -- the word "light"
refers to the color! As to virgin oil, I don't know much
Last, but certainly not least, the fat that every "non-HIV"
American wants to avoid: Saturated Fatty Acids (SFAs) These
have a bad reputation because they can lead to heart attacks.
Upside down again; not with HIV/AIDS! SFAs, or "sat fats" are
hardly oxidized at all. Found in meats, dairy products,
cheese, butter and margarine, they include the so-called
tropical oils: coconut, palm kernel and palm oils. Middle
America has been told that coconuts, for example, with their
highly-saturated oils could give a heart patient a coronary
just looking at one! For HIV/AIDS purposes, it may be the
best bet oil of all.
Which brings us to the very very best HIV/AIDS oil of choice,
medium-chain triglycerides (no wonder it needs the MCT
nickname!). These special oils are just about all that there
is in coconuts! MCTs are not processed by the liver, and they
are easily admitted into cells without carnitine for
immediate energy. And they don't float in the bloodstream in
futile cycling-they do exactly what we want them to do--give
direct, immediate and useable energy. They're the best, and a
good buy if you need to gain weight and have liver trouble,
high blood triglycerides or fat malabsorption. Rare though
these fats may be, they are so good that I recommend seeking,
finding, and buying MCT food products like "soul-food"
macaroons, coconut milk, some protein powders and a few
nutraceuticals (meal-in-a-can type products). Heavyweight
Gainer 900 power protein powder is full of MCTs. Also,
nutraceuticals like Lipisorb, Nutren and Peptamen are all
high MCT-containing products. Other products may be out there
that I don't know about--if you find one, call me so I can
write about it next time Nutrition Power turns to fat.
New "Food Facts" Labels
These may be an improvement over the older model, but they do
take some adjusting. I think the best number to get from
labels is the number of grams of fat. Then your "fat budget"
can be monitored more easily, counting fat grams. Using the
old "percentage" method, you might find that celery gets 15%
of its calories from fat -but celery is almost a
negative-calorie food--and it definitely isn't a good protein
source! Don't go nuts--(full of polyunsaturated fats, by the
way)--with the percentages--use the fat-gram-counting
Don't forget who you are. Use information like this when you
need it! Maybe ordinary fat's a good answer for you. You're
probably OK if your triglycerides are normal, and if your
"stool" requirements are normal. But when something goes
south on you, get the fat figured out and start feeling fine
with Nutrition Power.
As always, first do no harm. If any advice here is, or seems
to be connected with adverse consequences, contact your
doctor or dietitian/nutritionist.
(Jennifer Jensen MS, RD, CNSD is in private practice for
individual consultation. She offers a sliding scale for
HIV/AIDS and always welcomes your call at 310.450.5581.)