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Being Alive

Perfecting Protein


Being Alive 1998 Feb 5: 6

Pyramid Power Several years ago, our Great Government went into the Pyramid Business. Its entry is called "The Food Guide Pyramid." After spending hundreds of millions of dollars and over three years of hard work and debate, our thrifty, nutritionally-concerned Government, came up with The Food Guide Pyramid. Our tax dollars at work! According to this pyramid, we should get most of our protein from dairy foods and meat/meat-alternate foods.

Doing Dairy Foods here include milk, yogurt, cheese, cottage cheese, etc. Let's start with milk. Your first task in the dairy department is to find out whether you have any digestive difficulties with milk. The most famous of these is lactose intolerance. Scientifically, this reaction occurs when the enzyme lactase, which should be digesting lactose, is either missing or inadequate. If you are lactose intolerant, you probably already know it. Exposure to milk causes belly-bloating and makes gassy, watery and painful diarrhea happen. And it has a certain "aroma"! There is a broad range of reactions to this not-uncommon phenomenon. Where one person's stomach does cartwheels just looking at a glass of milk, another can drink a half, but not a whole, glass of milk. Our ability to safely eat yogurt and cheese may range along that same scalebut these dairy foods are easier to digest because they contain much less lactose than milk. I urge you to eat/drink what you can from the dairy group. Besides providing "gold-standard" protein, it's easily our biggest dietary calcium food type, and calcium is a hugely important mineral.

Most people associate calcium with bone health. And they're right; calcium does participate in the bone-health system. But calcium has a much larger role: it's so vital that our blood has to maintain a "steady-state" calcium level, and it achieves this by taking calcium from bone to increase blood levels, or putting calcium into our bones if our blood already has enough. Calcium is involved in virtually every chemical reaction in our bodies; one of its main duties is helping our nerves "talk to" our muscles. Think of calcium every time you blink your eyes.

You'll probably need a calcium supplement even if you drink a lot of milk. Your daily requirement is 1500 mg, and each dairy serving can count for 300 mg. For supplementation, before going to sleep each night, total up your day's dairy servings (300 mg each), then take enough of your supplement to make up for the difference between what you ate and the 1500 mg that you need.

Yogurt can be special; it tastes really good to a lot of people, and it's packed with nutrients. Yogurt is a gut-friendly thing to eat too, because lactobacillus acidophilus is truly wonderful gut-food. Unfortunately, however, it's not even in many brands of yogurt; read labels carefully. And cheese: tolerance to cheese, including cottage cheese, tends to follow the yogurt harbingerthose who can eat yogurt may be able to eat cheeses. And those who can't digest yogurt may have trouble with cheeses too. Caution: don't eat moldy cheeses like brie, camembert, and other soft cheeses; these may be risky; molds aren't always healthy to eat.

And for our current Protein Review, all of these foods are good protein providers. Pyramid wisdom calls for 23 servings each day. For this, a glass of milk represents one serving. Since all dairy foods can be fat free, we can count our servings with relative freedom from fat fear. The protein in a glass of milk, regular, 2%, 1%, or nonfat (skim), amounts to about 8 grams. A slice of cheese or a container of yogurt gets you roughly seven grams, and a small, half cup serving of cottage cheese will provide, at about 14 protein grams, a real good source. Here's one more little note: there is no difference in the amount or quality of protein between various levels of fats found in dairy foods. But the calories can range wildly! Meat Protein The Food Guide Pyramid calls for 23 meat servings. When the word "meat" is mentioned, beef is often the first thing that jumps into our minds. Beef is an excellent protein source for savvy HIV eaters; it's packed with important vitamins, especially B2 (which is our leading protein-handling vitamin), and lots of major minerals like iron and zinc and selenium.

You may remember when meat was not on the "A-list" because of its high fat and cholesterol content. This is not so much of an issue these days. About 1020 years ago, "prime" beef was expensive and a status symbol; it was highly fatty and well "marbled"the little sinews of white running throughout the meat that confer flavor and calories. And it was the most expensive meat typeespecially important if you were entertaining important people. Current knowledge about fat and cholesterol wasn't knowledge at all in those times.

Now, with 90s-level health information on fat and cholesterol, and modern technologies for rearranging how cattle can be raised, often they are free to roam ranches and frolic in the fields. Also, many of their diets have been changed. So now, our better beef buys have much less fat, almost no marbling, and can be safely eaten, in moderation, as a heart-healthy protein provider. I haven't even seen a prime meat offering for years. So, beef is a fine choice for healthful, nutrient-rich protein provision.

Great! Now we can truly have it all: A down-home meal of beef, baked potato (with gravy if you want), veggies, and a dinner roll. Just like in an old-style restaurant, only better tasting, healthier, and hugely cheaper. Now you can carry roast beef sandwiches to work, school, or doctor appointments, make 15-bean soup with beef and barley, create that fabulous au jus French roll sandwich, and maybe even make a beef casserole.

Poultry Protein Other meat types contain about the same amount of protein as beef, but not necessarily with the impressive vitamin/mineral numbers of beef. Cook poultry well for food safety. For all poultry forms, the dark meat has the best flavor, and contains about three-times the amount of fat as its white other-parts. The protein values don't change with meat color, but some of the nutrients, like iron, zinc and vitamin B2, are not as generously provided in white as they are with the darker cuts. If you're on a tight budget, buy the bird whole, and cut it up at home. Be sure to wash cutting boards and utensils very well; they tend to be a bit germy.

One nice thing about poultry is that you can cook it with the skin, and provided you remove it before eating, you'll get no more fat than you would if you had cooked it skinless. Also the meat's more flavorful and moist when cooked with skin. I personally like to sprinkle seasonings, and stuff garlic and onion between the fat and skin, bake the bird, then de-skin it for true taste titillation.

Another method is to boil the chicken parts. Add spices and other flavor enhancements into the waterthey'll get under it's skin, so to speak. And you can still wait to remove the skin after it's well cooked. Then, pour off the juices and do what you can do with the beef juices, for gravy and brothor a little pan of chicken soup perhaps? Fish Protein Fish can be fairly cheap, and requires very little kitchen savvy to cook. Flavor tampering can range from the simple lemon or lime squeeze, to exotic herb sauces and exciting marinades. But if it's undercooked, and you eat it anyway, forget dessertgo right to the hospital for an emergency antibiotic drip to deal with all the toxins you just consumed. Those little germs and worms and thingsthey can kill you and things like that. Look carefully; the flesh must be really flakyno mushiness is allowedat all! And here's a really financially friendly fish findtry shark! It tastes a lot like swordfish, but it's actually much better, and a good basting with a simple lemon-butter sauce, turning it over a few times for renewing the basting will make you the talk of the fish circuit! But a note of caution: A lot of people get sort of greenish if you tell them you're serving shark. Don't worry; just tell them it's swordfish! I had a situation one time where my significant other loved "swordfish" until I revealed that it was really shark. Then I was asked to never cook shark again. But I did anyway; and just passed it off as swordfish (which can run about twice the price of shark).

There's a really neat health bonus with fish. Fish Fat!often called Omega-3 fats or fatty acids. Abbreviated as EPA and DHA, these are truly healthful, and are best found in white albacore tuna and salmon. Without diving into too much scientific detail, let's just say that fish fats lead to better prostaglandins, which control cytokine blends in a beneficial way. And better cytokines is a really smart thing to shoot for. So, fish truly is a good healthfood.

Egg Protein Eggs can be a bit controversial. There's this huge myth about cholesterol from eggs raising blood cholesterol. This is true for a few people, those who are genetically prone to heart disease; most of us are not, and egg-eating won't do us in. So, that being said, I'll simply point to the medical literature and state that no study has ever found egg-eating to be connected to high blood cholesterol. That's not open for debate; it's just a truth. About 80% of all the cholesterol we have in our blood was made in our livers from fat; saturated fat. Eggs do contain some saturated fat; from 12 grams out of their total fat content of 57 grams. That sat-fat content isn`t so significant, in a low-fat diet of about 40 fat grams per day. And eggs do have some good protein, another "gold-standard" entry, so egg eating can be quite healthy and a cheap protein fix. But not for all day every daybe real! An egg will give you 57 grams of protein; an egg's worth of an egg substitute may provide more; read your labels and keep a running total for the day.

Ms. Food Safety steps in to caution you on one major thing about eggs; they can kill you if you eat them undercooked. The HIV yolk must be hard; salmonella is there and it can not only give you a good case of diarrhea, it can travel to your brain and infect your gray matter. Don't lose gray matter just to eat a runny egg; that's not very brilliant. If you're at a restaurant, send it back; your life may depend on it. Get what you ask for: a hard-cooked egg.

Meat Alternate Protein Meat Alternates include legumes: beans, peas, peanuts and lentils. If diarrhea is a concern, beans are not your best diet choice. For protein content measurement, legumes may lose you. But if you learn to "eyeball" the size of one cup (practice this at home), you can use about 1H to 2 cups of legume mixtures to count as one protein serving.

Totaling Protein As mentioned earlier, we're supposed to get 23 dairy servings, and 23 meat servings each day. Here's the least complicating calculation I can come up with: For dairy, count each glass of milk, cup of yogurt, or slice of cheese as one serving. And be sure to total up your calcium for supplement-taking at night. For meats, it can be tricky. A serving is 23 ounces of meat, poultry or fish. And for meat alternates, use 1H2 cups as one serving, and a gas-plus-diarrhea caution on the legumes. You'll need 23 eggs for an egg-based meat serving.

The average Positive Person needs about a gram per pound of body weight. And this is a very rough estimate; everyone is different. But it does serve as a protein goal, and that's about as much as we can do with Nutrition Power for a lot of Positive People who are reading this.

For our Pyramid Goals, let's see how we do. If we get in 3 dairy servings at 8 grams each, that gives us 24 protein grams. If we eat 3 meat servings, as meat, use the chicken breast technique. The average chicken breast is about 3H ounces and contains roughly 2530 grams for a daily total of 7590 grams. On the high side of meat, the total is 99 grams (90 for the meat and 9 from the milk). On the low meat side, it's only 83 grams. Clearly, the Pyramid totals won't make the HIV gram-per-pound goal. But the Pyramid is for HIV-negative people. Change that last chicken breast to a 6-ounce steak, and you're getting there.

As always, first do no harm; if any of this is, or seems to be, connected to adverse health consequences, contact your doctor or nutritionist.

Jennifer Jensen, MS, MBA, RD, is in private practice, and always offers a sliding scale for HIV clients. She welcomes your call to 310.450.5582, or send e-mail to


Information in this article was accurate in February 5, 1998. 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.