Appetite Control

Appetite Control

Essential knowledge from basic Nutrition 101 comes first here. Facts to review before reading this article include knowing that calories are our energy units. We all need a specific amount of calories just to lie in bed and breathe. The number of daily calories needed tends to run high with HIV/AIDS. So we may need more fuel to keep up with ourselves so that we can do more than just resting in bed. Watching soap operas, for instance...okay, bad example. How about getting up out of bed and eating that great food packed away in the fridge? That does require above resting-level calories. How many calories do you need? That’s individual and is also connected to your state of health. It depends.

So, we often need to increase our calorie intake just to "break even." But then we may have some trouble if our natural appetite doesn’t supply enough energy to allow us to actually use our bodies. By the way, one of the most important activities we can choose to spend energy on is building lean body mass (muscles); that is, exercise. Exercise also tends to increase appetite -- One-stop shopping! But there are other tricks to control appetite, so stay tuned for the good stuff: Control-- what a concept!

SFM

This is a nutrition term that means "small frequent meals." It’s the kitchen-science equivalent for nibbling. It may be helpful to know that we’re really living in prehistoric bodies. Evolution hasn’t made much of a difference in the last 10,000-years or so -- remember, we’re still born with an appendix that may have been useful to prehistoric man. And, what prehistorics did in the food eating department was grazing; another name for SFM.

In prehistoric times, cave dwellers would scout for food; they would go up a hill, eating whatever they found, then another hill, with another selection of natural delicacies, etc. I don’t think they sat down at a table, with candle-light and a glass of wine, for a romantic evening. Probably they were too busy with other food things like getting to the next hill before other hunter-gatherers hit it first.

Like a Car

Most people already know about this, but for a miles-per-gallon refresher: If you drive around town, stopping, starting, and getting into bumper benders, your car will get seriously bad mileage, and it’s engine will wear out quickly too. Yet, if you tank up and hit the interstate, you may get 400 or even 500 miles out of that fuel fill. Also, even at the higher highway speeds, that car will last longer and run smoother. It’s better for car engines to run at a steady (any speed) pace. It’s the same for our digestive tract, i.e., the "gut." Why treat your car better than you treat yourself?

Like a car, our guts don’t like working hard, then stopping, then working again. So, nibbling is probably the best way to eat regardless of HIV status; just more of a "must" if you're positive. The scientific name for big-meal-eating is gorging. Gorging is the opposite of grazing; it’s what happens on a one, two or three meal-a-day. Anyway, most nutritionists and dietitians recommend the SFM system. Like the old cave man and the new car, we’ll do better with more frequent feedings to go longer and last better, as we keep gut health in mind. Also, with the well-spaced "3-meal" program, we can get into trouble; hard on the gut and fuel foolish. It’s best to follow our natural rhythms; eat a grazing nutrition lifestyle instead of gorging. We need to get back to nature and give our bodies the raw materials for a good food day.

After some practice at the SFM-style of eating, your body will begin to remind you when it’s feeding time. You’ll find that appetite will happen just when the time is perfect...because any time is perfect.

The following hints may be helpful to get started. We need to eat all of the calories we can for the energy we need to have a good health day. Usually, we need to rely on boosting daily food-fueling levels. Give these a try; you might be amazed!

Make Each Bite Count

If you want/need to gain weight, and you have a smallish appetite, don’t eat low calorie foods like salads, diet popsicles and other non-energy foods. A good example is the lettuce-based salad -- even with Romaine leaves. They have almost no nutrients and can waste valuable time and energy in the eating process. And its high fiber content can create diarrhea if you’re lucky enough to not have it already.

It gets worse; salad greens are packed with water. In fact, I just call lettuce "crunchy water." Before a main course, it’s kind of like drinking a glass of water before eating -- it can sort of pre-load your stomach before it has a chance at real food. There are more reasons to avoid salads. The lettuce and other salad greens are a bitch to clean and those leaves do get pretty dirty. Make the salad more substantial; ditch the lettuce and pour salad dressing over french fries! Now that’s a meaningful food. And it’s "Upside Down" (another article) from general nutrition health advice offered up for HIV-negative dwellers.

For readers who think that spinach is a member of the healthy club -- I have news for you! With spinach greens we have a bigger food-safety hazard; they’re much harder to clean than other greens, and I don’t know anyone who loves crunching the sand attached to spinach. Also, spinach contains a corrupt natural toxin called oxalic acid. This toxin goes to the gut and combines into a soapy scum (binding, in science-speak) with essential minerals, including its own calcium and iron, and making such a big and slippery slime, that the minerals never get into the general circulation. Bottom line, the spinach and minerals will get right to the bottom -- the bottom of, well, you? Shit still happens! Watch out for chard and rhubarb too.

Even from a salad-basher, if you go for salads with a mixed variety of vegetables as a base, you’re on your way to good vegetable health. At least there are nutrients -- but they still tend to come with that fiber and water duo. Use great salad dressing and remember that this is where the flavor and energy units are -- most veggies are pretty low in calories.

The 10-Minute Window

Usually, when appetite happens, it only lasts for a short period of time -- about 10-minutes. Translated into lifestyle, this means that when you get hungry, you’ve got 10 minutes to find and eat a SFM-based quantity of food; use the window to best advantage. To help with being prepared, I suggest remembering this word (I may have invented it): Grabability. Knowing that only 10 minutes separates us between appetite and non-appetite, we need to get to food fast. Driving to fine fast-food dining establishments may take that 10 minutes. What do you do with the health burger once you get it, and now there’s no appetite? Far better, pre-purchase fast cooked or pre-made foods. Even with microwave frozen dinners and entrees, you may need to nuke for 8 minutes or more -- leaving just two more appetite minutes. By pre-cooking convenience foods, you create even more convenience; you can re-heat them in 2 minutes, and eat for the next eight. Works for me!

"Dine"

Meals can be so pleasurable if, unlike the cave dwellers, you light a candle, pour some fruit juice or nectar into a wine glass -- you could also pour wine if you want to -- and maybe enjoy your meal with someone special. Food always tastes better when it looks nice. (Also, cars run better when they’re clean, don’t they?) Are you saving your good china for special occasions? Once we make appetite happen, the fact that you feel like eating at all may be a special-enough occasion. Why treat your guests better than you treat yourself? Speaking of which, what if you simply don’t like eating alone? Find some strategically selected individuals to eat with you. Who knows, maybe they need an eating buddy too!

Fluids

As mentioned earlier, pre-loading your stomach with liquid beverages is not a good appetite idea. This is Nutrition Power knowledge: Sip fluids with those small meals, and save the heavy (non-alcoholic) drinking for in-between feedings. Sipping works particularly well if there are mouth sores or tenderness in the gumline; liquids with mini-meals can be used to pre-soften hard foods -- from toast to tenderloin. And, while on the subject, one more reminder: The better we chew our food, the more digestible it will be.

As a people-watcher, I’ve noticed a lot of food-inhaling -- that’s the totally wrong thing to do. What your mouth doesn’t do, your intestines have to -- overworking the gut by requiring it to make up for non-chewing. This can bring on gas attacks, indigestion, and bellyaches. Try using this Nutrition Power hint: Count your chews; if you’re not to thirty, you’re not done. So if those little "poofers" (from not chewing carefully) stink -- start counting! Then you can appear in public without embarrassment. I may be the slowest eater in the world, but I never get gas, bloating or indigestion. Well, only once in a while . . .

Appetite Stimulants

Have you tried everything and appetite’s still not happening? Tell your doctor. The most commonly prescribed appetite stimulants are Megestrol Acetate (Megace) and Dronabinol (Marinol). A few problems have been noted with both: in particular, gaining weight but adding fat instead of muscle. All the eating in the world won’t help if you just sit around looking at your arms and legs expecting muscles to grow! Instead, proper use of appetite stimulants means that we add on lean mass (i.e., exercise), and there’s no pill for that -- yet. And again, exercise itself tends to improve appetite.

Megace is a good appetite stimulant. It’s chemically related to the female anabolic hormone progesterone. Use it either in an oral suspension (like a not-awful-tasting cough syrup) or take it as a pill; either way, appetite will improve. Prevent wasting; do whatever you can to add on lean muscle mass!

Marinol is also a good appetite stimulant. It has "THC," the active compound from marijuana, in pill form. Used correctly, it will provide you with an old "60's" syndrome: The Munchies! There may be a downside with Marinol -- the munchies may bring around a little euphoria or inebriation. Driving a car (or other safety-needs activity) while on Marinol may not be a very good idea. But if taken at bedtime, overnight Marinol will be creating a huge case of appetite in the morning. This is what I call a "calorie opportunity." While it may violate the grazing and nibbling behavior suggested earlier, it might be a real plus to begin the day -- and also to recover from unwelcome weight loss.

Which should you use? A few things to keep in mind. Doctors may be hesitant to prescribe addiction-potential medications, especially if you have a recreational drug history. And Marinol is an addiction-risk drug. As far as doctor-hesitancy goes, just have them take care of any addiction you may get in about 10-15 years! Also, if you’re in a recovery or 12-step program, your sobriety should be considered; it’s your call. It’s possible that Megace could "argue" with testosterone replacement therapies -- the guy/girl thing. We just don’t know if or how much; neither of these medical cocktail additives have been studied enough for certainty.

So, as the individual person living with HIV/AIDS, work things out with your doctor, and use appetite stimulation as is appropriate. But do be pro-active; if you’re losing weight due to insufficient calories and/or opportunistics, give your doctor a call, or pay him/her a visit. Any unplanned weight loss is always serious, even if you want to get rid of a little bit of heftiness. Understand that wasting is sneaky; don’t let it get you -- it can be prevented. Get the correct help when and where you need it.

Anabolic Steroids

The main thing to know about medical use of anabolic steroids is that they have not been well studied. Medically, there’s some kind of knee-jerk reaction to using this strategy, mostly because experience belongs to body-builders who have abused them. We really don’t have enough medical data for steroids to make a firm overall recommendation. What has been learned so far is that there are some expected exclusions. Kaposi’s Sarcoma (KS) may be worsened by steroids, and also may be wrong for individuals who are prone to depression or other psychological problems particular to HIV/AIDS.

The currently used steroids, suggested for men, include testosterone shots (ouch!), the Testaderm Patch (cute), Nandrolone, and Oxandrolone (double ouch!). It may be appropriate to use Progesterone for women with HIV/AIDS, to override any potential masculinizing effects; most women don’t want to grow a beard! Preliminary results are encouraging, but we really don’t have much in the way of safety guidelines. And, again, you can’t acquire lean mass just by sitting around waiting for muscles to grow. If you’re thinking about anabolic steroids, or appetite stimulants, take these medical interventions seriously: Work your program! And listen to your doctor’s advice.

Steroids on the horizon include recombinant human growth hormone (rHGH) and DHEA (dehydroepiandrosterone) -- aren’t abbreviations wonderful? Also under consideration is Thalidomide, another knee-jerk reaction from the 60's (it caused a lot of birth defects). If you think steroids may help you, check this out with your doctor. Most people living with HIV/AIDS aren’t trying to avoid birth defects.

All You Have To Do Is Drink . . .

But you’ll need to drink the right things and drink enough. No matter how bad appetite is, or how nauseated we can become, we can always drink. From personal experience I rebounded from a 60-pound weight loss, by drinking -- the right stuff. We know that trying to eat larger amounts of food, with or without appetite stimulation, can be overwhelming. This is where nutraceuticals can become big-time important parts of your healthcare plan. (The term "Nutraceutical" combines NUTRition and PharmACEUTICAL to create this term for medicinal nutritionals.) Nutraceuticals are therapeutic, high-calorie/high-protein drinks, soups, power bars and puddings. Actually, even instant breakfast qualifies: it contains good calories and vitamin/mineral delivery, is cheap, easy to find, and OK tasting.

Probably, Ensure is the most well-known nutraceutical, but it’s not specific to HIV/AIDS or any other specialized concerns. There are a lot of canned/boxed beverages out there and your dietitian or nutritionist can offer great help in selecting your own personal-needs concoction of best benefit. Most of us who work in HIV/AIDS care are familiar with the various formulations and can advise products for your specific needs. A referral to an HIV/AIDS nutrition specialist can be provided by the American Dietetic Association (800) 366-1655.

After getting a recommendation, finding that particular nutraceutical may not be easy, especially since most specialized formulations are often not in stock for over-the-counter purchase. However, you can order these products from specialty pharmacies like North American in Van Nuys (800) 577-3579. Be sure to ask if they’ll chase your insurance provider or MediCal/Medicaid on your behalf for payment or reimbursement. It’ll make a world of difference by uncluttering your other paperwork things.

Flavor Control

When it comes to the taste of these drinks, we need to know a lot about re-arranging their flavor. In general, it’s best to purchase vanilla, since it can be turned into so many other flavors. I’ve developed a list of flavor-control products that are readily available in most supermarkets:

FLAVOR CONTROL
Chocolate Syrup
Butterscotch Syrup
Strawberry Syrup
Caramel Syrup
Tang (pinch)
Jell-O (pinch)
Crystal Lite (pinch)
Kool-Aid (pinch)
Cocoa Powder (pinch)
Instant Coffee (pinch)
Jams/Jellies/Preserves
Canned Pie Fillings
Fruit Nectars
Frozen Juice Concentrates
Pureed Canned Foods (baby foods)
Mashed Bananas
Other Fruits
Flavor Extracts (sold near spices)

Pulling It All Together

Wasting can be prevented. Either eat more or drink more, or both! And do consult your doctor or dietitian for recommended feeding strategies. Remember too, that if wasting is to be prevented, resistance exercise is mandatory.

And, as always: First do no harm. If any of this advice is, or seems to be, connected to adverse consequences, call your doctor or dietitian -- or both.

Other versions of this article have appeared with permission in Being Alive Newsletter, Arts & Understanding Magazine,and other newsletters.