Being Alive 1997 Apr 5: 9
With all the information available about nutrition, I thought
it might be helpful to put things in order, to set some
priorities. Make Nutrition Power work for you!
Perhaps surprisingly, our first Nutrition Power priority may be
fluids. That's right! Still, up to half of hiv-related hospital
admissions are for dehydration. Weight loss will follow, given
the nature of hospital living. And it's widely suspected that a
hospital isn't exactly a germ-free environment.
How does dehydration happen so much for Positive People? The
most obvious fluid losses are from diarrhea, vomiting and
sweats. Other fluid losses are less obvious, such as when
muscle fibers break down. Muscles are packaged in our bodies
with water, so when they are broken down, hydration status may
suffer. Another non-obvious method of dehydration is when we
find ourselves in a hot, dry climate. Here, we could be
sweating without knowing it-our moisture (what a good word for
sweat!) is on the move and evaporates so we won't feel sweat
happening. Nature and her trickery.
To prevent dehydration, drink at least two quarts of fluid per
day-a good maintenance method. And when we have one of those
"special" days where lots of fluids are lost, the requirement
is urgent to replace these obvious losses by adding enough
fluids (over the 2-quart minimum) to replace, ounce for ounce,
drop for drop, all that has been lost.
What to drink? Ideally we should turn to a dedicated
rehydration beverage, a wide range from infant fluids to gator
drinks. With hiv so much of a fluid intake is necessary, that
we'll likely get to the right fluid balance from most of the
more "general" fluid sources; just drink from a variety of
Here's a trick that's kind of sneaky. Work out (resistance
exercise) enough to add on muscle. The new muscle will be
packaged with water-which will improve overall hydration.
While on sneaky tricks, here's another: Eat salty foods like
chicken soup, crackers, or pretzels. The salt will make thirst
happen, we'll answer to the call by drinking, and that salt
will then help hold onto fluids-women have been water-holding
Once fluids are taken care of, calories are our next concern.
The most generous calorie sources are from fat-it packs in
almost three times the calorie-count from either protein or
carbohydrates. As to the health of eating high-fat foods, look
to the specifics in other areas of your food plan. If there is
balance happening, the extra fat load may be a real plus for
calorie gathering activities.
If fat is not an option for you (e.g., pancreatitis, liver
disease, malabsorption), the best bet is eating a lot of low-
or non-fat, high calorie foods. These are surprisingly easy to
find. As an example, notice the very low- and non-fat pastries
at your healthfood store or supermarket. Their serving sizes
are pretty small, so they can really pack in the calories for
very few bites. Are these "health foods"? No! But they're
high-calorie foods, and this section of priorities, after all,
is about calories.
Our next nutrition priority is protein. Science still hasn't
given us any perfect protein estimates for hiv, but one gram of
protein per pound of body weight is almost always a safe bet.
The best sources of protein are eggs, dairy (milk, yogurt,
cheese, cottage cheese), meats (beef, chicken, fish), and
legumes like beans, peas and lentils. Soy protein is also a big
Of these, the best bet for Positive People may be beef. Right!
What you may have learned about the nutritional problems of
beef-eating in the recent past was usually not suggested with
hiv in mind. All nutritionists and doctors know that protein is
important; my own recommendation turns to beef as one of the
best sources. It contains iron, zinc, other minerals, and
vitamins that are simply unavailable elsewhere in our diets.
Since beef can be high in fat, choose leaner cuts like London
broil and roasts.
An ounce of meat, an egg and a glass of milk all come to about
7 grams of protein. Look at food labels and note the protein
grams disclosed. Count your grams until you're comfortable with
meeting this important goal.
Supplements are absolutely essential. If you are not taking
supplements, you should start. If you are already taking
supplements, make sure that what you're taking is balanced.
Many dietitians and nutritionists can provide good advice to
avoid over-consumption-which could be risky. Also, we're good
at ensuring sufficiency-not based just on bottle labels; this
is just for good advice from qualified experts.
I receive lots of requests for information about
supplementation, and have prepared the following guidelines to
help to make sense of the pill maze that may exist in your
health-food store or pharmacy. First a definition: vitamins and
minerals are called "micro-nutrients."
* The Recommended Dietary Allowances (RDAs) do not take into
account the enhanced needs required for good hiv nutrition.
Thus these may not be useful guidelines. Vitamins, minerals
and antioxidants support metabolic activity-and metabolic
momentum speeds up a lot with hiv in the Big Picture. This
may make a case for increased speed and subsequent extra
* The related B-complex vitamins are often sold as a "balanced"
formula of milligrams: 25 mg, 50 mg, 100 mg, etc. I suggest
an upper limit of 100 mg for this type of supplement. Beyond
this, you may be paying for more than you need. Sometimes
B-vitamins are included in daily "multiples". Make sure
you're getting at least three times the various micronutrient
RDA levels, then see a hiv-sensitive counselor to refine this
* Special characteristics of vitamin B-12 seriously interfere
with its absorption. Either injections (self-administered) or
sub-lingual B-12 (dissolves under the tongue) is recommended.
* For vitamins A and D, both fat-soluble vitamins, the level of
twice the RDA is appropriate.
* Generally thought of as self-made by our intestines,
sometimes we may lack Biotin (a B-vitamin) and vitamin K.
Supplements may be needed to make up for conditions where the
intestines have been abused-like with antibiotics.
Finally: Nothing Works Alone
A good nutritionist can help you determine and acquire what you
need, avoid or limit what you don't need, and help everything
else work better together. Another message: medical attention
doesn't work alone either; without attention to nutrition, it
also is incomplete.
For a review: Without fluids, calories won't work well. Without
calories, protein won't work well. And without vitamins and
minerals, the calories, protein and fluids are not going to be
able to do their work in helping metabolize the other three.
Nothing works alone!
Naturally, should following this advice be, or seem to be,
connected with adverse health consequences, consult your
nutritionist for professional advice.
Jennifer Jensen, MS, MBA, RD is in private practice. She offers
a sliding scale for hiv/aids and invites you to call her at
310.450.5581. Or send e-mail to NutPower@aol.com