Then comes a tiny whiff of trouble. Your bathroom "rhythm" is off a bit. So is its aroma; a sure whiff test! You don’t get enough rest. You’re tired, sluggish, dowdy, sleep-deprived, unkempt and pitifully faded. But stuff like this just happens every now and then with HIV; no need to worry. And that’s right, it isn’t at all unusual to go in-and-out of good/bad cycles. It’s when things like this happen a lot, subtle changes can go unnoticed. So, un-annoyed, you proceed to live your life as usual -- ups and downs included. Good stuff starts happening and you sense the beginning of a great new beating-aids-thing, and life goes back to peachy and beachy. Ah, so much fun!

Later on, you get into another HIV-flare up -- a small molluscum, perhaps? Maybe a rash, falling-out hair, diarrhea? No big deal; the meds are working, your numbers are good and there are a whole lot of new meds and miracle things in the pipeline. When flare-up-type-things happen, they now seem less important thanks to polydrug therapies, protease inhibitors, and mixed cocktails.

These agents tend to make CD4 and Burden numbers jump around a lot, mostly in the right direction. Also, unfortunately, some of the protease drugs are beginning to fail. Coasting on all the fun, you sometimes might not be highly aware that you still are HIV+ and you still have to manage this chronic disease. It’s kind of like a diabetic taking insulin. That’s a group of people who have to pay serious attention to healthcare; the diabetes patient knows that you go to the hospital near death if you don’t follow the rules.

It’s not all that much different with HIV. Daily seriousness is absolutely necessary, numbers notwithstanding. If you’re doing good, remember that you did a lot to make that happen; now it’s time for optimization and scrupulous management. That’s why I’m sometimes concerned when I hear of HIV+s who actually do just coast, ignoring all warnings and cautions. This is the syndrom called "If you’re feeling OK, who cares?" You’re not in real danger, and things do tend to go up after a slight fall. You wait and get by -- ‘til you get into another "good" cycle. I suggest you pay more attention -- to nutrition! There are specific dietary requirements, distinctly for HIV, and nothing you’ll see in the newspaper, magazine or news program will give it to you. And if you follow HIV diet principles rigorously, you can win.

Is it really OK to accept the good news that you’ll just have "chronic" problems so long as you’re able to get multi-drug control of both the virus and it’s OIs? Where does nutrition fit in? Why worry about your diet -- You take your vitamins and don’t eat junk food -- How can that be improved? Nutrition Power has something to say about that -- read on.

If you already are on a good, high calorie, high protein diet, including vitamin-taking, spending some time with an HIV-specialist nutritionist/dietitian could make your good life even better. We can solve problems, and a whole lot of the little irritants of HIV life, using nutritional strategies. Try Nutrition Power as a medical Co-Therapy! It works!

About Doubts. HIV is serious. Now, however, with fewer hospitalizations, less time in doctors’ waiting rooms, and way less pills, it’s hard to stay centered. Curiously, since we are doing so well, there’s a chance we could really be letting ourselves down. Maybe the diet gets less protein than it needs -- some days? Could it be that you almost always skip lunch? Do you weigh enough? Are you bypassing your supplements? This is a major violation, and it may be the worst of all.

Food alone cannot furnish all of the vitamin, mineral, and antioxidant needs of everyone living with HIV. I don’t think anyone likes taking pills, including me! Most of the people I know are taking 20-50 pills a day. A good friend, Bo, once said "It’s when you’re doin’ good that you start gettin’ sloppy." I couldn’t agree more: Don’t get sloppy! Here are a few problems that a nutritionist can help you with. Fixing things.

I don’t know anyone, HIV or not, who hasn’t had enormous intestinal gas pains, head in the "bathroom bowl," and hoping-to-die experiences. For those with HIV, however, the timing of these events tends to get faster and faster, and we can just slip from one weekend into another -- not especially having fun. In the bathroom. Nutritionists are not immune to gas and bloating -- often with explosive events in the bathroom. Last weekend, for example, I myself had one of those experiences, so I’m able to report the incident with full recall. This is sort of like "coming out" when you’re a nutritionist. It wasn’t a pretty picture. But, it also didn’t last very long, thanks to a few tricks.

First, I took a handful of activated charcoal (I don’t measure, but about 8 capsules). This makes a lot of sense knowing how absorbent charcoal is: Would-be Bar-B-Qer’s know very well, the fragrant lighter fluid seeps into the charcoal chunk so fast that the chunk never even seems to get wet. What an intestinal breakthrough! I knew that something was trying to push stuff from my insides to outside; usually this is due to both fluids and gas. If it’s just gas, it may amount to a few embarrassing elevator moments, and that’s enough for me! If it includes fluids, it's probably an occasional diarrhea. You can buy charcoal capsules at any health food store and most pharmacies; they’re not expensive. Worked for me!

Second, I applied a bit of knowledge from Chemistry 101. Heat makes things happen faster. So I got out a heating pad for my tummy. It immediately relieved some of the pain. It also tends to encourage speedier movement in the intestines. Whenever whatever is trying to get out gets closer to getting out, the sooner our personal torture will end. Heating pads aren’t expensive and they’re over-the-counter.* As long as you’re being charcoaled and heated, you’ll feel better -- sooner. One Stop Shopping!

If these remedies don’t seem to take care of the whole job, you may need to go to some anti-gas preparations. Some of these are: Gas-X, Simethicone, Pepto-Bismol, Mylanta, Alka Seltzer and similar products. Alka Seltzer offers a "plus Tylenol" product. This gives me an opportunity to advise against any of these products containing additional Tylenol (Acetaminophen). This agent causes reductions of our antioxidant high-light, glutathione.

After a gas attack, there’s good news, the first is -- it’s over! Second, we have an opportunity to apply therapeutic supplements to heal and re-constitute the tender tissues lining the gut wall. Food First: Glutamine is the essential nutrient for our intestines. We can’t get enough glutamine into our bodies right after such a "cleansing." So, I headed for a hit of glutamine (GLN). I’ve written about this amino acid before, but not everybody reads everything I write, and here it can be a good reminder anyway. And honestly, this is newly written -- I’m not even going to try to retrieve anything from my computer archives -- I’d need a crew of computer consultants to do that (any volunteers?).

Just as a small tutorial, the following is for readers who might not be biochemists -- it’s cool to know things anyway. Protein is constructed from amino acids, the so-called building blocks of protein. There are about 22 shapes and sizes in the amino acid arsenal. We can make 14 of these ourselves, as the protein in food we eat gets processed and rearranged. The other eight essential amino acids will be used as needed, while supplies last, that is. The gut itself has to be fed -- and it eats mostly GLN.

Supplemental sources are a safe way of acquiring enough glutamine. Meat, fish, poultry, dairy and egg proteins are all "complete" -- they have all eight essentials. Other foods like breads, rice, pastas, veggies and legumes have incomplete proteins, but when combined can become complete. But we're still not sure if enough glutamine gets into the circulation just from dietary sources, so we still have cause for concern, diarrhea or not. There are supplements, but first read up on it.

Glutamine is the primary fuel of the gut. This is the part of protein that maintains your insides while restoring their function after they’ve been broken down; something that happens a lot with hiv/aids. So, with damaging and rampant intestinal assault, glutamine is promoted to an essential amino acid. We have to eat a lot of protein every day just to get enough amino acids for making the amount of GLN we need to nurture and heal our digestive system. In fact, getting enough glutamine and other specialized amino acids is why the estimated HIV protein requirement is more than double what would be suggested for Negatives.

Isn’t it neat to know bio-science? Here’s a little extra: There’s more GLN in our entire body than there is of any other amino acid. Also, about 80% ( 8 out of 10) of the amino acids inside our intestines is GLN; it is the perfect nourishment for our intestines and is their primary nutritional requirement. Obviously, then, if intestines are ravaged by chemotherapy, colonoscopies, antibiotics or diarrhea, a grand-slam GLN infusion could be a Big Plus! Glutamine treatment can speed up the recovery process, that’s great -- and it may be the only way to really heal the gut.

So, out of my bathroom, as soon as I could, down went a 10-gram dose of GLN. The next morning I grabbed another dose -- I use GLN regularly anyway. At least my intestines will have enough energy to digest food -- I’m overjoyed! Remember, if it does not get handled right in the gut, ALL of our meds, vitamins, minerals, and food will be of virtually no use.

This is a good example of why my profession, nutrition, should get a higher priority on the healthcare list. Insurance might even reimburse for it, Medicaid and Medicare might even pay for it, maybe HMOs would emphasize it. After your success with glutamine, be sure to tell your doctor how well it worked!

[SIDEBAR: Glutamine can be found in Ross’s Alatraq (800) 227-5767, and Sandoz Nutrition’s Vivonex Plus (800) 999-9978. Your pharmacist can special-order these and the various Medicare/Medicaid programs may pay for them. Both of these products will need a bit of "Flavor Help." Another option is to order directly from Cambridge Nutraceuticals (800) 265-2202. This needs less flavor support and is more Financially Friendly if you’re paying your own way.]

Now for my next hint. Yes, we’re still on the subject of gas when it accompanies violent and abusive diarrheal explosions. You are extremely dehydrated if you’ve just gone thru a diarrheal ordeal. Fluids have to be replaced and we’re not just talking thirst-quenching. Here, we have to measure our intake because thirst is not anywhere near a good indicator of fluid needs. Of course, everyone should be drinking at least two (2) quarts of fluid every day -- from safe water to diet sodas (HIV or not).

After a bout of the big "D", begin a rehydration protocol that includes at least one extra quart of an oral rehydration solution (ORS) every day. This is a combination of electrolytes balanced to match exactly what you lose. It’s probably best known as Pedialyte by Ross. Whenever I shop for it, I tend to notice that store brands, with the same ingredients, that are cheaper. Other acceptable products include Infalyte by Mead Johnson, which may be found next to Pedialyte, and CeraLyte, which can be ordered from (888) 237-2598; it’s usually even cheaper than the store brands. While Pedialyte and its clones are simply electrolyte mixtures, Infalyte and CeraLyte include rice syrup which is a really good way to control diarrhea. Those rice solids are really something!

Taste isn’t important if you’re drinking to quench a huge thirst -- like after exercise, but for drinking pleasure (or just getting your minimum), you may want to add a pinch or two of an exotic-flavor Crystal Light or Kool-Aid -- makes you look forward to that dose. In addition to your ORSs, drink fruit juices, diet sodas and safe mineral water. Herbal teas can count too. Japanese green tea, though lacking somewhat in the flavor department, is filled with those wonderful phytochemicals. And don’t forget soy milk, rice milk and cranberry juice.

The next job in gut repair is to restore biological balance, i.e., correcting the bug equilibrium and stabilizing acid/base (pH). Most people I know have some knowledge of acidophilus. It’s a good thing to know of, and opinions differ wildly from one nutritionist to another. In talking to company sales reps, I’ve learned that there are various special things about assorted culture strains and biological species. I credit the notion that some cultures are probably better than others. But there can be a huge price difference from one group to another. Since there is such a wide range of pro-biotics, including bifido bacteria, bulgaricus, lactobacillus delbrueckii, and lots of others, it’s hard to know how to even manage to select one! Again, See a Nutritionist.

For "in general" acidophilus selection, strategy is everything. You can always start cheap and work your way up the price ladder if necessary. So, from the low end, start with a small bottle of health food store acidophilus. Store it in the refrigerator, even if it wasn’t in one when you bought it. My current recommendation for dosing is from two-to-six times a day. The "dose" amount is simply a swig out of the bottle after shaking it vigorously. Precise measurement is not required. Swish the fluid around in your mouth (you’ll hurt lingering candida -- bad), then gargle down the rest, in hopes of getting surface contact with the lining of the esophagus; it’ll kill off more candida there too. I call this the "swish, gargle, swallow" technique. Once in the malaised intestines, the remedy can repopulate its surface area with "friendly bacteria" for perfect Flora.

You may want to know if your remedies are working. One way to tell if you’re getting benefit from your work is probably through aroma awareness. If you’re friends make a quick exit when you enter the bathroom, that could be a sign. You may need either more of the acidophilus you’re using, or get into a higher, pricier, or more elegant pro-biotic. This can get expensive -- temporarily, but the reward is having a digestive system that works. One that can handle all of your needs; food, supplements, and medications(!) -- getting them securely into your bloodstream. This is a good thing to have happen.

Other considerations for regaining intestinal health include some herbal therapies. Ginger has long been famous for easing the troubles of digestive distress. Grind powder from ginger root, and sprinkle it on top of lots of things -- from pizza to pea soup. Flavor-testing is creative and a fun subject to talk about with your friends, and then you can all be better digesters.

Another one is peppermint; good at calming tummy-rumbling -- borborygmus in science-speak. (Impress your friends.} I first discovered this after indulging in three peppermint candies after a south-of-the-border feast. Like instant relief! (Is this why this kind of restaurant hands out peppermints with your invoice?) Sucking peppermint candy all day isn’t a solution for maldigestion. Be creative; try peppermint tea, find uses for peppermint flavoring (near spices in the store) in everything from a power shake to herbal tea (lemon peppermint?). It’s especially good in green tea -- a powerful duo.. Phytochemical Power!

Aroma therapy may help. Eucalyptus, Rosemary and Apple-Cinnamon have worked for others, test the spice rack out for yourself -- that’s the only way you’ll find your own individual best aroma -- kitchen aroma, that is. Your pharmacy or health food store may offer aroma-therapy products. If it works, use it! My personal favorite aroma therapy flavor is eucalyptus; calms me and my system down flat.

And don’t forget comfort foods. Nothing makes things better than a can of chicken soup. Even the new, so-called healthier chicken soup (which has a little less salt, and less satisfaction), still gives a high salt delivery. This can be an enormous help with rehydration: The salt can make thirst happen and make you drink more, and the salt will also help hold fluids inside your body to maintain that well-bloated, super-hydrated condition.

Followed by a light custard dish. Sometimes I think I’m addicted to Flan, and it’s easy to make. Tapioca is a good one too, and it may also act medicinally against diarrhea. Yet another useful tool is the sugar-free popsicle. It’s the direct equivalent of drinking a Crystal Lyte or other fruit drink. Reyhdration can happen with many more than just one treatment choice -- and there are, at last, choices! Personally, I’m hungry for some custard. Yes, nutritionists do get hungry too. Lunchtime!

*Use caution when applying heat therapy. If you have any concerns about heat application, call your doctor; heat isn’t such a good thing in some rare cases.

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First do no harm: If any of this information is, or seems to be related to adverse consequences, contact your doctor or nutritionist.

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Nutrition Power is a Registered Trademark of Health and Nutrition Awareness. Copyright 1997 Jennifer Jensen, MS, MBA, RD.

All Rights Reserved.

Another version of this article has appeared with permission in Arts & Understanding Magazine.