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Being Alive
Figuring Out Fat
Jennifer Jensen, MS, RD
April 5, 1995
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 inch.

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 wonderful? 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 Futile Cycling 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.

Dietary Fat-Amount 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 about virginity.

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.

MCTs 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 technique.

Individuality 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.)