Now you have it! Your intestines, and mine, should all look like this, tiny little blades of grass, the user-friendly equivalent of "villi" -- the internal gut structures’ real names -- which are present in the gut, ready to make absorption happen! And what do I mean when I use the term absorption? First, I'll have to define another term:

Digestion is when the gut breaks food down into its smallest possible size, often to simple molecules (very very tiny). This process is mostly done in the first 10 inches (the duodenum), of the small intestine; not the stomach. (Betcha didn't know that!) The duodenum makes its own digestive enzymes and also uses enzymes made in and delivered from the pancreas, liver, and other GI-tract members.

[There's a bit of a "myth" about digestive enzymes in saliva. It's a kind-of yes/no situation. True, enzymes may be there, but they make a rather insignificant contribution to efficiency in the digestive enzyme power pool. Bottom Line: If you should suddenly cease to produce salivary enzymes, there are the different, higher-capacity digestive system counterparts just mentioned, ready to take on the whole job.]

Absorption is when digested nutrients (from food and supplements), along with meds-by-mouth, are passed through the intestinal wall to the bloodstream. The "grassy" surface area includes thousands of those little blades of grass, or villi, in the intestine. From the inside to the outside walls of the gut, the tiny digested particles are pushed through to the bloodstream for target tissue transport.

From our topsoil sample, its sort of like fertilizer being placed on top of the grassy surface, then traveling through root structures to underlying ground areas. If you take all of the individual "blades," front, sides, tops and bottoms, and stretch them all out alongside each other, you’ll have the surface area, and therefore the absorptive potential, the size of a basketball court! Of course, this almost never happens.

As food passes down the intestinal canal, the tips of the grass-like villi get snipped off at the tip -- "sloughed off" in science-speak (pronounced "sluffed"). It takes the villi about five days to grow to their full height for best absorption. And about 1/5th of the tip of each villus is lost by daily sloughing action. It’s sort of like a lawn-mower -- clipping the grass on the lawn by 1/5th every day. The sloughing action has us shedding our gut lining daily, to account for roughly 1/3 of daily poop. It’s also a huge drain on our protein resources; the torn villi have to be repaired, and a lot of our dietary protein is used for just this purpose.

Some degree of good gut health is required for nutrients to get to their destination, and this tends to be especially fragile in Positive People. First, HIV has its own impact on the gut, through many various, and some unknown pathways. Then, as we eat more food and extra protein for good HIV-specific nutrition health, and as we take more medications that keep us alive and things like that, the added stress more than rips the tips; so this "side effect" requires even more protein and more nutrients and it never stops. And the "lawn-mower" is tip-clipping fifths away; rarely resting.

If you think you’re home safe, know this: All Opportunistic Infections (OIs) can affect the gut. Actually, OIs can go anywhere they darn well want to -- salmonella can infect the brain, tuberculosis can infect the intestines, and Kaposi's Sarcoma (KS), a skin cancer can develop in all organs and tissue types throughout our bodies. Even intestinal blockages can occur from KS!

The last thing I want to do is add more confusion, but the small intestine is also an impressive immune-cell making machine -- representing another "arm" of intestinal function. The type of immune cells made here (immunoglobulins, especially IgA) are not the same ones as the CD4s (T-cells) that get depleted from HIVs actions, but they’re what’ll get you through a cold or the flu.

The floral bottom line is that we tend to lose some of the nutrients contained in our food. So you can bet that there’s altered or impaired gut function, which can bring on that old HIV/AIDS standby: Malabsorption. This can lead to malnutrition which can lead to the wasting syndrome, and then to death or maybe worse: Morbidity -- "pain and suffering." Yes, it’s a big plus to keep the gut flora as healthy and happy as that new virgin-green lawn.

Yes, it is fixable, but first you have to know a little bit about a "conditionally essential" amino acid, Glutamine (GLN). It’s the most abundant amino acid in the body, and is the primary fuel for the gut; about 80% of all body GLN is in our intestines. Think of it as fertilizer for the lawn. How much do we need? We can use from 10-50 extra grams each day, depending on current gut-growth rates and the types of medications we may be taking.

Your bathroom aroma can tell you a lot about when and how much is needed. Start with ten grams; if your aromatic outcome is better-but-not-great, adjust the dose upward. If "outcome" is perfect, stay at the 10 gram amount three times a week. That should be enough for maintenance therapy. If outcome drops a few notches in the aroma arena, go back to taking extra GLN every day. Where to find GLN? One source is supplemental GLN (in pills/capsules), but the co$t and huge handfuls of pills for the 10 grams you need can be very high for "project gut repair."

Nutraceuticals are food and liquid supplements that have therapeutic value. The word combines Nutrition and Pharmaceutical -- Medicinal Nutritionals! Some nutraceuticals contain Glutamine. One is Ross’s Alatraq (800) 227-5767, and another is 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.

I was the first and only nutritionist for Project Angel Food in Los Angeles (home-delivery meals to PWAs) for many years. We once had a client who had massive malabsorption due to MAI. He couldn’t handle even a few tablespoons of broth -- this is serious! Since we had some donated Vivonex we sent him three envelopes a day. The going rate then was about $10.00 per envelope, which at first blush, seems pretty pricey. But, after two weeks of this particular glutamine therapy, he was eating burgers with the works, fries and shakes. He loved it! And even if he was paying his own way, the fix would have cost less than $500.00. Compare this to some of the stuff PWAs pay for that may or may not work, and this was quite a bargain after all! He went back to work from disability, and subsequently, moved to another state. Happy Tails!

Lawns need bugs and so do guts, where they are called bacteria. As our lawn needs insects like ants, ladybugs, and worms, our intestines also have an animal population -- a sort of intestinal eco-system -- of roughly 400 different microbes. If flatulence or bathroom therapeutics have that familiar "aromatic" essence, it could be a signal that gut bugs probably aren’t in correct balance anymore. There’s quite a bug turnover inside the intestinal canal; two for one, every 20 seconds -- all day, every day. That’s a lot of breeding! No wonder another third of our daily poop comes from dead bacteria! (I’m not making these things up!)

The intestinal bugs support digestive function and help maintain the appropriate acid/base relationship in the gut. This is where Candida can step in. If the gut is too alkaline, Candida can grow -- sort of spreading up through the stomach, into the esophagus (which is an AIDS-defining condition) and mouth where it is known as "Thrush." It can also go south on you and that’s usually called diarrhea. An aroma challenge indeed!

As if that weren’t enough, there’s the antibiotic angle. Use of antibiotics like Bactrim/Septra, Dapsone, Cipro, Biaxin, Azithromycin, and others, may tend to rearrange our intestinal eco-system. A lot of people with HIV take antibiotics. This can further shorten the villi, making full-grown healthy ones even more scarce. The villi just atrophy (die) and become dysfunctional. And our "basketball court" of absorptive potential is starting to look more like a ping-pong table.

Acidophilus cultures may be helpful for restructuring bacterial inequality. As its name implies, acidophilus might help to break the alkaline barrier and begin repopulating intestinal ecology. Hopefully, the cheap stuff will work. I’ve seen some remarkable turn-arounds from generic liquid types. To take the liquid approach, I suggest the "swish-gargle-swallow" technique. For this, don’t bother using a tablespoon to measure your dose, just shake and open the bottle, take a good healthy swig, swish it around the mouth, then gargle -- prolonged surface contact with mouth and throat membranes fighting Candida may be a really good thing to do -- then swallow slowly. Only one bottle per person, OK? You know, germs and things.

The taste may not be silkenly wonderful, but if you want a cheap fauna-fix, this may do the trick. One really good way to fix flavors is to use cranberry juice or gel-type sauce; a fabulously great, fruity health potion. Other ways to get acidophilus include capsules, powders (to be mixed), and more expensive brands with varied types of creature counts of acidophilus and pro-biotic cultures. I’m not providing brand specifics; there are plenty of selections at your neighborhood pharmacy or health food store. I don’t live in your wallet, so I can’t help you determine how much you should spend in this department, but the "start-cheap method" is a good way to test your needs -- you can always climb up the price ladder later, if necessary. Surprisingly most yogurt sold in markets doesn’t contain acidophilus; read ingredient labels carefully.

First things first -- food (including power shakes) needs to run through the intestines several times each day. For some reason, this actually tends to prevent sloughing too much of our flora, and keeps the fauna of bacteria happy and balanced. A couple of days without the stimulation of nutrients inside the gut tunnel can erode both the flora and fauna. When this happens, it can become a case of villus atrophy -- the "wasting away of a body part or tissue," according to the Webster Family. Any erosion of villi equals less capacity for absorption -- of food, nutrients and medications. Regular feedings can help prevent this. Primary absorption improvement -- heal the damaged parts. I call it "Keep the gut working." An alternative reminder is the "use it or lose it" formula -- a pretty good descriptor of what happens to unused body parts.