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Being Alive

Nutrition Power "Turnaround": Don't Believe Everything You Read


Being Alive 1997 May 5: 5

This article is about suitable nutrition principles for most people with hiv/aids. If you are in doubt about any of these issues, consult with your physician or nutritionist.

Food and Disease History When scientists are looking for information about any disease status, especially in the case of nutrition and its relationship with health, they look for populations of people with the disorder they are trying to outguess. Then they look at the nutrition numbers (data) for people with and without this disorder, and try to match dietary practices with outcome. For example: consider heart disease. Researchers look at people who have heart disease and compare their cholesterol numbers with people who have not suffered cardiovascular damage. They have found that arteries clogged with cholesterol are present in people with heart disease. They then look at how to either prevent or heal these cholesterol blockages. This same process is true with hiv/aids. Interestingly, the specific problem with heart patients (elevated cholesterol) is nearly the exact opposite for hiv positives. With hiv+ people, we start to worry if cholesterol levels drop too low! (We always knew we were "special," didn't we?) Average America High cholesterol, the nemesis of middle-class America, is the last thing most people with hiv/aids need to worry about. Actually, people with hiv/aids need to be concerned if cholesterol drops too low! That's right: cholesterol has been used in many scientific studies to monitor nutritional status of hiv/aids, and decreasing numbers are usually not a good sign. Often, when deciding how to conduct our nutritional selves, we'll read advice in magazines and newspapers, see it on TV, hear it on radio, find it on The Web and overhear gossip. Do you actually think these communications are targeted to hiv+ America? Yeah, right! Negative America What everyone reads and hears about is diet advice for middle-class America. We hear that a diet high in saturated fat, for example, is bad because it raises blood cholesterol. And that's truesaturated fats, found in meats and so-called tropical oils like those of coconut and pine kernels, are true risks for Middle America, but from the hiv/aids corner, some of our most useful oil types are exactly these: coconut and pine kernel oils. These special oils, clogging the arteries of the Middle, may be good, even therapeutic, for Positive People.

The saturated fats from Nature are called medium-chain triglycerides (MCT). These can be the Perfect Positive fat typeand MCTs are 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! Having made the point of just how special are hiv/aids, let's look on the bookshelf. The best and only place you'll get hiv-specific and current nutrition advice is from newsletters like this: any book would be outdated before it ever got to press! And that's why I call this Turnaround. Take what you read in the "popular press," and do almost the oppositefrom diet to exercise.

Salads Again? I keep indulging in "salad bashing"it's so easy! Take the common leafy salad. For Middle America, salad is a perfect food. It has no significant nutrient value, almost no caloriesgreat crunch to lose weight, and with low- or non-fat dressing, it's really just a "flavor carrier." That low-cal salad can take a long time to eat.

Lettuce (including romaine) has almost no nutrients. It gets worse. The green stuff packs in the water it holds between its plant cells. 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. Middle America loves this roughage, which promotes easier, quicker bowel movements. But Postive People beware: lettuce contains enough roughage to make a bad case of diarrhea worse, and cause a good case of diarrhea for those lucky enough not to have it. Good for the majority, not good for those who are not constipated! Another Turnaround.

And lettuces are a bitch to 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 breaththey're called "sneeze-guards" for a reason! Hospital life is so tedious! 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 particularfor hiv-specific nutrition healthcare. 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 Negative person. Turning around and around.

The reason that hiv-negative Americans need to eat less meat is because of the fat and cholesterol. For this the no red-meat "rule" was devised. For Positives, red meat is not only a good protein provider, it's also a natural way to acquire iron, zinc, vitamin B6 and other important nutrients. 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 hiv/aids diet. Don't say "Ugh"think pat�. Maybe you like liver more than you thought.

Pork Too? I once saw a nutrition handbook warning against all kinds of meat, and pork in particular. Maybe this dates back to Biblical Law, where pigs were dirty (think "pig sty aroma") and pork was not, and still is not, Kosher. (Happy Passover!) While I have no quarrel with Biblical law as practiced then, I must carefully point out that pork is our very best source of vitamin B1, (Thiamin), necessary to digest carbohydrates. A recommended starch intake is about 6070% of all food eaten so this vitamin is important. Yes, vitamin B1 is available in other foods, butit's awesome in pork.

Even Eggs? Then, there's the much-maligned Egg. Long out of favor in U.S. diets because yolks are full of cholesterol (whites are cholesterol free), eggs are invaluable for the diet geared toward needs of people with 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 Connection Having dispensed with salads, red meat, liver, pork, other meats and eggs, let's tackle just two more items in the average-standard diet. How about fiber? Since the American public eats only about 11 grams of fiber per day, but is advised to get from 3040 grams/day (to prevent heart disease and some cancers), the high-fiber diet is heavily promoted amongst healthcare professionals.

Sometimes, as with salads, that fiber may not be such a good idea, due to diarrhea. 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 a turnaround for the public (increase fiber) as opposed to advice for that special person like youdecrease fiber. Keep on Turning Around! Work Out The Workout Now for exercise! Since Middle Americans generally want to lose weight, high-level aerobic exercise is recommendedworkouts of panting/sweating exercise. Positive America, 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 should be geared to resistance training: weight-lifting. Adding muscle provides protection from wasting.

These are only general hiv-specific exercise guidelines; I'm not an exercise physiologist. How we spend our energy (calories) is just as important as the kind of energy we take in (food). I suggest that the next step towards a maximum, "personal-best" result is to consult a fitness instructor or exercise physiologist for an exercise plan. That isafter you have your nutrition in order! Another note: At least one of the new protease inhibitors (Norvir/ritonavir) may cause elevated cholesterol. Look for warnings from your lab results and from your family history. Families with multiple heart disease members should get specific advice from their doctor or dietitian for this rare event.

As always, if the advice in this article causes, or seems to cause, adverse symptoms, contact your doctor or dietitian. The advice in this column is not geared toward heart patients. Always check with your doctor if you're not sure.

Jennifer Jensen, MS, MBA, RD is in private practice, and offers a sliding scale for hiv/aids and invites you to call her at 310.450.5581, or send e-mail to


Information in this article was accurate in May 5, 1997. 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.