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?)
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!
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
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.
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
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.
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.
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
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
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 NutPower@aol.com