I don’t know anyone who doesn’t want to look good, do you? We’re all a bit vain, it’s a human-condition thing. And a scientific fact. We also tend to want to dress well and appear healthy and attractive -- any dog knows this. Moreover, I bet it’s safe to say that we all know a fair amount of really good looking people -- even great looking in some cases, yes? Curiously, most of these people often don’t think they’re all that great looking, or at least that’s what they say. In fact, they sometimes seem flat-out happy to point out their flaws. And at times, even after that, I might disagree and still think they’re attractive. Or, I’ll notice the imperfection for the first time -- they really shouldn’t point it out -- now I’ll always watch for it whenever I see them. Like "Oh, your nose really is rather huge."

Here’s another people category for you -- people who think they look fabulous, even though they don’t really look all that great -- to me. But hey, maybe they look great to other people, I’ll never know. Keep in mind that "Beauty is in the eye of the beholder." (The ‘beholder’ is the person doing the looking, for younger readers.) That’s when personality outshines even pitiful looks, so they really are lookers after all. It’s an individuality thing, and individuality is always good to keep in mind when dealing with HIV.

Then there’s you (and me). We have to form our own opinions about how good we look. And how much we’re willing to do to look our best. Here’s a suggestion about how to handle this perplexion with ease and diplomacy. Look your best, in your own opinion, and let other people decide for themselves how attractive you are. Don’t dote on your flaws -- if you have any, that is. If someone happens to pay you a compliment, don’t deny your good looks, just say "Thank You" and shut up. A smile might help.

Nutrition Power has it’s own opinions about attractiveness, and they have nothing to do with your face, hair, clothes or attitude. Actually, they have everything to do with your body compartments! Yes, when it comes to health and HIV, your personal amount of fat, muscle and water (hydration) is directly proportional to how "good" you look nutritionally. Nutrition Power’s appearance policy is that the more muscle you’re wearing, the better you look, and Nutrition Power cares about your health, and wants to help out if it can. (Did you think that Nutrition Power was some inanimate thing that didn’t think or have opinions, let alone emotions? Well, I’m Ms. Nutrition Power, and I am anything but inanimate!)

We’re living in a very special HIV time frame now, one that may create a different way to live with HIV long-term. We’re finding new life-options with cocktails, NNRTIs and Protease Inhibitors -- that are, or are not working -- and hopeful about some new meds that are moving towards us along the pipeline. Perhaps they could still make David Ho’s optimism about total viral eradication come true. But even with good drug news, the bad news is that The Wasting Syndrome is not going to disappear any time soon. And wasting is almost always connected to mortality; most HIV-deaths happen with some degree of wasting. And that's sad, because it never has to be like that!

Nutrition Power operates with the knowledge that HIV-wasting can be prevented. If there was a Nutrition Power pill, guaranteed to prevent wasting, wouldn’t you take it? (And I’d be rich!) Of course, that pill doesn’t exist, but a good remedy does -- use it and you won’t waste. If we want to avoid wasting, we have to pay attention to how good we look. Right; your health depends on how attractive you are -- in the body compartment department. Control over wasting must be self-induced -- it’s a bit of a job, but what a rewarding accomplishment when it’s well done! Not to mention looking great -- in all departments.

Wasting happens when we lose lean body mass (LBM). That’s the body compartment that includes bones, blood and muscle -- lots of muscle. It doesn’t include fat. So, in case you may have become a little bit lazy about your own body compartments, this is your wake-up call -- and a plan to get 1998 off to a really good start so that by 1999 you’ll be living in a body of non-wasting good health. And it’s simple; all you have to do is make yourself as attractive as possible. That will display (and be) your health status more than anything else. And it has to be done; you can’t just sit around waiting for it to happen. So get ready to move.

We’re always advised to be pro-active in our healthcare matters -- we have to participate with medical personnel if we want to live better and longer. And as far as nutrition goes, it’s not just eating the right foods, taking the right supplements and timing food events around drugs that have feasting or fasting rules. We can’t just sit down and eat even the best of nutritious foods; that won't prevent wasting all by itself. We have to actively pursue that important body-beautiful objective. It’s an essential start to begin eating healthfully, of course. You can't go far without fuel in the car; you need enough calories, protein, vitamins, minerals, antioxidants and so on -- every day.

Let's pursue this automotive analogy for a moment. For your car to run, it needs gas (energy). Then the car takes us where we need to go (Target's always high on my list), and brings us back; it’s daily work. Likewise, food (measured in calories) is the fuel that gives our bodies the energy it takes to keep us working all day -- heart beating, brain thinking, pulling out the credit card, etc. So, the math-like formula is, simply stated, energy-in (gas, food), energy-out (driving, living). Now we come to the point where cars and people part company, analogy-wise. When your car runs out of gas, it just stops -- till you put more in the tank. But our bodies are different. They don't have tanks. Our fuel is stored in virtually every cell in our bodies. So when we use more fuel than we put in, we literally start consuming ourselves. After a while, this makes for considerable wear and tear on our looks, i.e., wasting. And for Positive People, the cells we consume first are in our muscles! Our thin little muscles? Or, our bulked-out, buffed-up musculature? That's up to us. We’ve gotta make muscle happen. Read on --

How much should you weigh? This involves math and it’s important; get up, get out your calculator, and take down a few numbers. First, consider your height. If you’re a man, enter 106 pounds for your first five feet, then 6 pounds for each inch thereafter. If you’re a woman, use 100 pounds for five feet, and add 5 pounds for each inch over that. So a man who is 5’8" should have 106 + 48 for a total of 154 pounds. A woman who is 5’8" needs 100 + 40 for 140 pounds. That’s what nutritionists call "ideal body weight" (IBW).

Nutrition Power adds another calculation for Positive People. A "recommended body weight" (RBW), and that’s 10% over IBW. So our 5’8" man needs to add 16 pounds to his IBW, for a RBW of 170, and our woman needs to add 14 pounds for a total of 154, her RBW.

Do these weights sound hefty? Yes, I suppose they might, but consider this: It’s a scientific fact that muscle weighs much more than fat. So, if both of our 5’8" volunteers were to add muscle as the extra 10%, they’ll pack in those pounds without looking fat; indeed, they’ll look "buff" and buff is in. No, you don’t have to look like a muscle-bound beefcake if you don’t want to, but that simple bit of extra muscle will help save your life if you get sick. Life-saving is fairly important. The more muscles there are, the harder it will be to start wasting. And if you want beefcake -- go for it!

I can’t begin to tell you how many times I’ve heard this! Thin is an enormously anti-health state of body, and the Positive Thin Club (PTC) has a very big membership. Trust me, I believe you if you tell me you’ve always been thin, your family is all thin, and that’s a flat-out fact. And often an excuse for not building muscles. And sadly, with HIV, wasting is always a constant threat -- just hanging around the next health-corner, waiting to mug your muscles. That’s not such a good thing to have happen.

For "PTC" members to prevent wasting, a change in thinking on the "always thin" subject needs to happen. Modifying a mindset is a psychological difficulty; so if you need help, get it fast -- death from "always being thin" when the muscle-loss started happening, isn’t what any reader wants; at least I sure hope not. Mental rearrangement may be the most important thing you’ll ever do -- so do it. And get to the gym, add muscle, and prevent wasting -- in that order. Please notice that "prevent wasting" comes right after "adding muscle." It’s the natural cosmic order of things, according to HIV. The time is now. Not tomorrow. Not next month. And not next Monday. Now. Again, no pill, no good numbers -- nothing but extra body-muscle will prevent wasting.

There’s another HIV-Positive group in a different body-composition situation. Not-Thin Club Members can be anywhere from a little pudgy to gigantic. I have a really close friend who appears to be about 9-months pregnant and overdue. And despite my constant warnings, over many years, he didn’t take me and my suggestions so seriously. He was just looking in the mirror and seeing what he calls a "fat guy" -- and that doesn’t look like wasting at all! Yet my friend was just diagnosed with "the wasting syndrome" -- standing 5’7" and weighing 250 pounds.

One of the best disguises for malnutrition is obesity. Appearances can be so deceiving! If you’re in that club, resign. You don’t have to diet and get a better body; you just need to exercise and add muscle to the one you’re already living in. And "adding muscle" does not in this case mean adding weight. The excercise can change fat to muscle and that's how you add your muscle. Again, wasting isn't so easily detected if you’re overweight with adipose (fat) tissue; it just works away in secret, insidiously, and with deadly intent.

Can you recover from wasting? Well, yes and no. Yes, if it’s caught early-on and self-treated aggressively and enthusiastically. No, if it isn’t. Appetite stimulants can encourage high-level food intake -- get one if you’re not eating enough, or if you’re not at your Nutrition Power RBW. If your cupboards are bare, call an agency that provides free, home-delivered meals like Project Angel Food in Los Angeles, or Meals on Wheels -- they have community-based chapters almost everywhere -- call around.

For a better appetite, try to eat foods you enjoy frequently. If you like pizza, and it’s 6:30 am, eat pizza. Or, if it’s 6:30 pm and you don’t feel like a roast, have some pancakes. Or eggs, french toast, cereal, etc. There is no rule stating that what you think of as a breakfast food can’t be eaten at dinner time. And there’s every reason to eat dinner’s leftovers for breakfast. One really great idea is a peanut butter and jelly sandwich. This can go well for just about any meal without sounding a bit "off." But a tuna sandwich for breakfast? That doesn’t quite work for me, but if you like the idea, do it!

If you are, or think you may be wasting, this is really important. Since it’s not something you can feel, like a leg cramp, you’ll need another measuring device. My favorite is the jeans test; if your jeans have gotten too big for you, it’s possible that wasting is starting. Put those huge jeans away -- we’ll use them again to track your progress. Now, seriously get into exercise. If it causes pain, do it anyway. If it leaves you "winded," take it slower. If you don’t have a cute outfit to work out in, rearrange your thinking. If nothing in this article motivates you to workout, then resign yourself to the fate of wasting. When you're suddenly at about 2/3 of your usual weight, it'll be way too late.

Wasting can be treated, but again, it takes a huge amount of motivation and attention. The recovery process uses the same techniques as prevention -- and everyone in healthcare prefers that we prevent it. If we don't, it might not be possible to recover This should motivate every reader of this column.

Along with the "but I’ve always been thin" group is another that, well, the only word for it is, "whines". God knows, there's plenty of people with "good reasons" why they can't excercise. Everyone in healthcare wants you to feel wonderful and nobody wants to cause you pain. And if there truly is some physical thing that’s an honest barrier to exercise, there are still ways to handle things, so no whining, OK? I have a friend who coaches exercise groups of elderly and wheelchair-bound people who have a lot obstacles to excercising. When I see her working with these people, I see empowerment and rewards. They really seem to "get it" and they're very proud of every budding bicep and promising pec. They have decided to "exercise control" in their life. This is good. So seek out a trainer or physical therapist who can help you get past your "good reasons", OK? You need to "get" that you are in a no-excuses situation.

Do you have to join a gym? It would be nice, and the most user-friendly way to pack on muscles, but if that membership isn’t in your Financial Framework, look to the "Y" or to the brickyard. There is a point to make here, and it’s about priorities. Often when people think of exercising an image of running, cycling, or stair-mastering comes to mind. While this kind of aerobic exercise is important, it is not our first priority. The very first thing to do is lift weights. That’s why the brickyard may be important; they sell the cheapest weights you can buy. But, perhaps you can afford some hand-weights and leg-weights. They’re not very expensive (buy discount), and given the right exercise prescription, muscles can be added on for fine form. And fast too.

From personal experience, I have to say it’s really wonderful to reach over the table and feel muscles work that weren’t there before, or to stand up and find yet another set of muscles that you didn't even know you had. And if you're in that "always-thin" club, you’ll find that you don't need to end up looking too bulked up if you don't want to. Ask your gym maven, or read up. Libraries are everywhere. But if you're not in the thin wannabe club, those muscle shirts look really good on you, don't they?

And speaking of looking good, anabolic steroids are out of hiding now, and I have seen some remarkable turnarounds. I co-researched a study of anabolic steroids and have one dazzling case to report. One man gained 17 pounds in just one month. And 15 of those pounds were pure muscle, validated by tetrapolar bio-impedance testing. Even the distance around his upper arms grew by just over an inch during that one month. (I’m not making this up!)

That was four years ago, and he was definitely well-established in the wasting syndrome prior to the anabolic interventions. He’s still with us, he looks fabulous, and did not look then like he would be with us now. He got a lot of help from the ‘roids, but don’t think that’s all that happened. He went to the gym every day, ate a protein- and calorie-rich diet to provide for daily energy and muscle growth, and participated in his own recovery better than most of my other clients who are also still doing well. It’s about options, and knowing how to control the uncontrollable. It’s quality of life.

Once you have a quantity of muscle for wasting-prevention and protection, it’s time for conditioning! That’s where we can finally bring in aerobic work into our exercise programs. Walking is one of the best forms of aerobic work you can do. Walking fast, that is. Just meandering up and down the street isn’t serious walking, even if it is a nice diversion from sitting around alone all day. Also, it’s not pushing a shopping cart, though I personally find that a really fun thing to do! Yes, walking is good, even with sore body parts. And walking is free too. Mind you, stair-stepping, cycling and exercise groups are still good for aerobic exercise, but walking is the easiest and cheapest to do -- and stay with.

Aerobic conditioning is healthful in many different ways. First, thorough conditioning is always a big "plus" for anyone’s healthcare plan, and aerobics are great conditioners. Second, endorphins are produced when you go aerobic for over 20 minutes. Endorphins are self-made opiate-like substances that give off the famous "runners-high" that people find enjoyable, and they just happen to potentiate immunity too. So, as an encouragement to get beyond the weight-lifting-only stage and qualify for aerobic work, think of euphoria and immunity -- one-stop shopping! Just remember, it must be saved until those mega-important muscles are added on. Priorities are important, and adding muscles is first, because they may prevent wasting and help save your life. Honor HIV’s priorities.

You may be wondering just how to know when your muscles are plentiful enough to safely get into aerobic work. One way is to visit a nutritionist or health center that can measure your body’s composition. The preferred measurement for this is a technique called Bio-Impedance testing. It utilizes a held-held gizmo and takes about 10 minutes. The information you get includes your fat weight and percentage, muscle weight and percentage, water weight and percentage. The latter is a good check on the state of your hydration, which will increase, by the way, as you add muscle. Another important benefit!

The (RJL Quantum) machine for Bio-impedance testing is rapidly showing up in healthcare settings, even though it is a bit expensive. This means that you could find a test site at a local locality if you don’t want to travel too far. And it’s information is so valuable it would even be worth traveling far for if you had to. I’ve been doing testing in my office for over 8 years now, and the trend data can be very rewarding. You’ll find that charting your body-comp history is both informative and motivating.

Should you not have bio-impedence testing locally available, you can always go to the mirror and the jeans for a less precise test. In the mirror, admire more than your face: Stand and brush your hair (if you have hair), and watch to see if biceps and other arm muscles are getting distinctive -- it’s really cool to have distinctive muscles in the mirror where you can see them every day. Use a rear-view-mirror to find out if you have wavy muscles rippling down your back. And watch for that washer-board abdomen too. Ripples should be all over you. Get to a long mirror and admire your legs. Yes, the mirror is a good tool, and almost every homestead has one.

As to the jeans, put them on again. Are you still swimming in them, or do they have that fulfilled feeling? Have a seat -- I mean sit down. Look at your thighs. Is there more thigh than denim? Good, because for Positive People, the baggy look is out!

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First do no harm. Should any of this be, or seem to be, connected to any adverse consequences, contact your nutritionist or doctor.

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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.

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