Being Alive; March 1994
Jennifer Jensen, MS, RD

Fascinating Facts

Studies confirm that when living with HIV/AIDS, those who change their diets use guidelines for prevention of other diseases like heart disease and cancer. Don't misunderstand prevention of these maladies is very important. But, with HIV/AIDS, there is little risk of either, except for immune-related Kaposi's sarcoma (KS) and lymphomas.

Another fascinating fact: Heart-healthy aerobic exercise, while important for everyone's health program, is not to be overdone; it's important to emphasize muscle-building exercises like lifting weights and other resistance work.

So, when deciding how to conduct our nutritional selves, we'll read advice in magazines and newspapers, see it on TV, hear it on radio, and overhear gossip. Do you think these communications are targeted to HIV+ America? No way!

What everyone reads and hears about is diet advice for middle-class, "Norman Rockwell" America. We hear that a diet high in saturated fat, for example, is bad because it raises blood cholesterol. The HIV/AIDS counterpoint is that some saturated fat such as medium-chain triglycerides (MCT) can be the perfect fat type for us and MCT is 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!

Remember, 249 of 250 Americans are HIV negative. The only place you'll get HIV-specific and current nutrition advice is from newsletters like this (a book would be outdated before it ever got to press). And that's why I call this "upside-down." Take what you read in the "popular press," and almost always do the opposite from diet to exercise.

Salad Bashing

I keep indulging in "salad bashing" it's so easy! Take the common leafy salad. For the 249 out of 250 people who may need (or want) to lose weight, salad is a perfect food. It has no significant nutrient value, almost no calories, and with low or non-fat dressing, it's really just a "flavor carrier." That salad has very few calories and takes a long time to eat. Also salads contain "roughage" for promoting easier, quicker bowel movements. Upside-down!

There's still that one in 250 who generally doesn't need or want to lose weight. You've heard of "empty calories"; salads are "empty foods." Lettuce (including Romaine) has almost no nutrients. It gets worse. Lettuce packs in water, holding the fluid between its plant cell walls. 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; enough to make a bad case of diarrhea worse, and cause a good case of diarrhea for those lucky enough not to have it. Also, since salads do take time to eat, energy could be wasted doing unnecessary work. Good for the majority, not good for those of us who are not constipated! Upside-down.

But there's an even more important, and probably less well recognized problem with salads: Hard-to-clean salad greens! (Ms. Food Safety strikes again!) No matter what you do, or how hard you try, you're not going to get those greens totally 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 breath they're called "sneeze-guards" for a reason!

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 particular for HIV/AIDS nutrition health care. 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 HIV negative person with high cholesterol.

The reason that HIV negative America is told to eat less meat is because of the fat and cholesterol. For this the no red-meat "rule" was devised. But for HIV/AIDS, red meat is not only a good protein provider, it's also a natural way to acquire iron, zinc, vitamin B-6. 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.

And to settle a recent issue of mine: An HIV nutrition handbook warned against all kinds of meat, pork in particular. While I have no quarrel with Biblical law as practiced then, I must carefully point out that pork is our very, very best source of vitamin B-1 (Thiamin), necessary to digest carbohydrates. A recommended starch intake is about 60-70% of all food eaten so this vitamin is important. Yes, it is available in other foods, but it's awesome in pork.

Since those old pork rules had mainly to do with food safety, I'll just grab another chance to warn everyone (regardless of HIV status) to cook food well. Since heat kills germs, and modern refrigerators prevent spoilage, all that is necessary to avoid food-borne infection is to cook food very well-done, especially ground meats where every morsel not just the surface as in a steak may carry deadly bacteria. Just three words: Heat Kills Germs!

I also want to tackle, albeit briefly, the issue of animal protein versus plant protein. Here are some facts from science. Protein is made of strings of amino acids like uneven pearls. When protein pearls are digested, they break down into individual amino acids (22 shapes and sizes), which are sent to the liver and processed into living cells. Amino acids are chemical compounds and are exactly the same whether they come from an animal, a plant or (even) a test tube.

The Egg

Then, there's the much-maligned egg. Long out of favor in US diets because yolks are full of cholesterol (whites are cholesterol free), eggs are invaluable for the diet geared toward the needs of 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 Diet

Having dispensed with salads, red meat, liver, pork, protein sources and egg conflicts, let's tackle just two more items in the Norman Rockwell diet. How about fiber? Since the American public eats only about 11 grams of fiber per day, but is advised to get from 30-40 grams/day (to prevent heart disease and some cancers), the high-fiber diet is heavily promoted among health care professionals.

Sometimes, as with salads, that fiber may not be such a good idea, due to diarrhea. But, remember, 249 out of 250 Americans want and need more fiber they're constipated! 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 upside-down on the advice for the public (increase fiber) as opposed to advice for that special 1/250th person (decrease fiber).

One, Two, Three, Exercise

Now for exercise! Since HIV negative America generally wants to lose weight, high-level aerobic exercise is recommended often multiple workouts per day of panting/sweating exercise. For HIV+ America, the minority, 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/AIDS must be geared to resistance training weight-lifting. Adding muscle seems to afford some protection from wasting (a future article).

The HIV-infected body is different from others. Since weight loss is usually more of a problem than a desire, unnecessary calorie burning needs to be kept to a minimum, while adding muscles for that so-called "lean mass" is emphasized. Thus, the weight training and muscle building should be emphasized.

These exercise guidelines are very general because I am not, and never will be, an exercise physiologist. How we spend our energy (calories) is just as important as the kind of energy we take in (food). For that, I suggest that the next step towards a maximum, "personal-best" result: consult a fitness instructor or exercise physiologist for an exercise plan. That is...after you have your nutrition in order!

(Jennifer Jensen, MS, RD, is in private practice, and serves as nutritionist for Project Angel Food. She offers a sliding scale for HIV/AIDS consultations. Don't be shy call her at 310.450.5581.)

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