HERE WE GO AGAIN

Yes, the holidays are in full swing and lots of us are really happy this year. Cocktails and new medications are changing the face of HIV/AIDS. So, there’s more than enough reason for celebration (about better health), and for seeing long distance friends and family, plus the opportunity, or just a plain ol’ excuse for eating what might normally not be among our customary food choices. Does it have to be Thanksgiving or Christmas to roast a turkey? Here’s one shopping tip: Turkeys are at their all-time price prime for enjoyment during the entire Thanksgiving, Christmas, New Year holiday season -- every supermarket has flocks of them to serve as sales and/or promotional items during our winter doins. And rather cheap, from an economic perspective.

A Nutrition Power First here -- a Nutrition Power Recipe -- for Turkey and Gravy. Turkey practically prepares itself; you won’t need to work very hard. A thrifty turkey tip for shopping is this: Since turkeys of various sizes have about the same amount of weight in bones, get the Biggest Bird you can find; it has more meat-per-dollar than smaller versions. While you’re at the market, other shopping list items include a meat thermometer, frozen chopped onions, stuffing mix, and that huge, one-time-use pan for your bird. Get two; it’s good to double-layer them for oven protection. Does anybody want to perform oven-splatter clean-up duties?

Your stuffing mix has part of your shopping list printed on the box. Be sure to pick up what you don’t have. Prepare the stuffing according to package directions, but don’t even think of putting it inside the turkey (possible bacterial contamination); instead, bake it in a casserole dish. This can be done anytime -- even a day or two before the Main Event. It will warm up quite nicely in a microwave or conventional oven, while the turkey is cooking itself later on.

Do your turkey early in the day. To prepare: Dig out the gizzards from the neck and end cavities and put them in a sauce pan with water; simmer covered all day -- add more water if it runs a bit dry; all parts should be beneath the surface. For the turkey itself, replace the gizzards with frozen, pre-chopped onions, and seasonings (to your taste) for cavity flavor. Tie the legs together and secure the wings. To cook, put the turkey into a 325-degree oven, breast-side down(!) -- let natural drippings drizzle down to saturate the breast -- cover loosely with foil. The onion and other spices you put into the cavities can do a good job of seasoning your preparation.

Throughout the day, look in on your turkey at least once per hour. At some point in time, the bottom of the cheap roasting pan will show up with a lot of juice. Look for it. That’s when you should turn it over to brown the breast. Try to ignore a little red "thermometer thing" that your bird may have already implanted, use your own, more accurate, meat thermometer. Continue cooking until the bird hits at least 185 degrees inside at the deepest part, the breast. It will take about 5 to 8 hours to cook a 16 -24 pound bird. The cooked turkey should stand to cool for at least ½ hour before carving -- time enough to make the gravy and warm the stuffing.

Gravy is so simple! But people either don't like, or don't know how, to do it. I'm always the gravy-maker, even when I’m the guest. Now, you can do the same since practically nobody seems to know how to! When the turkey’s done, remove it carefully and place it on a platter. Pour all of the turkey juices into a bowl, add scraped tidbits off the sides of the pan, then ditch the pan. De-fat the juices by putting the bowl in the freezer. The fat will float to the top, and after about 15 minutes you can separate it and pour all of the newly-nonfat juices and tidbits into a huge frying pan. Pour in the gizzard water too, then ditch the gizzards. They’re repulsive.

During your 15 minute "freezer hiatus" mix about ½-1 cup of white flour (brown won’t work) with nonfat milk or milk substitute. I like to use a jar that can be shaken to do the mixing -- it turns out smooth, un-lumpy gravy. Gradually, add the flour mixture to the meat juices over a medium-hot burner, whisking constantly (the whisk breaks up lingering lumps). Season this with salt and pepper "to taste." If your gravy gets too thick, add more milk; if it’s too thin, add more flour. You simply cannot make too much gravy; you’ll want it for leftovers. So, keep on pouring and whisking, and the wonderful gravy you make is a huge "thank you" whether you’re hosting or visiting. And your gravy is almost 100% fat free!

Back to cocktails, a few things have become obvious in my nutrition practice. One is that, as we are all aware, CD-4 counts are rising and viral loads are dropping. But for some audience members, these numbers are not doing so well anymore. Maybe this could also be a time to get more serious about our personal nutrition healthcare. Let’s look at the good side of protease inhibitors, non-nucleoside reverse transcriptase inhibitors (NNRTIs), and new uses of old NRTIs (AZT, etc).

Don has been really sick and miserable over the years. He’s gone through lymphoma, chemo- and radiation therapy (4 years ago), was hovering over one remaining T-Cell last year. Now he's proudly showing up with a non-detectable viral load and nearly 800 T-Cells!

Tom, on the other hand, is losing his hold on barely 200 CD-4 Cells, and has a wildly climbing viral load. Also where Don has lots of chances at new drugs should his numbers start going in the wrong direction, Tom has been through all of the presently available meds, and must depend on lotteries for new drugs that are still under compassionate use. And for many of these new drugs, you can’t have been on "this one" or you must have failed "that one," or maybe he has to have "over 200" CD-4 cells for yet another one.

Both Don and Tom look physically well, but actually, Don is being congratulated and Tom is getting acutely worried. With numbers going in the wrong directions and no place to turn for new meds, Tom is tilting toward depression. So we have two different scenarios and two separate mind-sets about their individual, personal health prospects. And now the Holidays! This "you must be happy this month" season can be really overwhelming; emotionally and physically.

Seasonal Affective Disorder (SAD), combined with the events of October 26-27, might head us toward even more emotional trouble. You may remember that back in October we turned our clocks back, and that made night come along in mid-afternoon. SAD has been noted and studied seriously for quite a few years, and has acquired the highest honor of psychological warfare -- a well documented psychological syndrome-with-an-acronym -- SAD. And it can be -- very.

The best do-it-yourself treatment for SAD is surrounding ourselves by light. Some researchers have detailed out how much light will do the trick and how long it will take. If SAD is not, for you, a serious threat of death-by-suicide, perhaps you don't need light therapy, or expensive psychological help, because this occasion of depression is both predictable and has a definite end-point -- we’ll have daylight savings time again in April. Besides, SAD is fairly resistant to normal psychological treatment. (I mean no offence to any psychologists by this.) SAD can ruin your sense of well-being with or without a shrink.

Naturally, however, if you are seeing a psychologist regularly, toss SAD into the mess that you’re working on, and hope for the best. Otherwise, try to use daylight time judiciously; spend as much time in natural bright light as possible. Even on an overcast day, being outside may give you some light therapy that may help out. In sunny Southern California and its geographical neighbors, we tend to get more light than counterparts in northern states, so come visit!

The demands of holiday cheer (yes, sometimes we have to act happy even though we’re not, combined with non-seasonal depressions, can really get you. HIV just complicates things and sometimes makes ongoing depressions much worse. Hopefully you had a great Thanksgiving, but as you well know, other holidays are ahead, and just thinking about the merry-making you’ll have to do can be a real problem. Also, as you may have noticed, holidays and food are always found in combination with each other. So don't let a food-borne illness add to your holiday problems. Be mindful of all food and water safety warnings. Keep hot things hot, and cold things cold -- and when it’s your turn at the buffet, avoid warm, room-temperature food that’s been at room temperature a long time -- it’s a serious risk, so don’t.

How’s your health? There are two new classifications of HIV-life that I’ve recently noticed, and quite apart from holiday/winter depressions these are new concerns of a nutritional nature. First is cholesterol, and I’m completely blown away by this. I never would have predicted it, and am now trying to deal with it for myself as well as with my client population. All HIV-savvy healthcare practitioners (including nutritionists, to be sure) have been downplaying the role of cholesterol in HIV-life, because we were only worried if it dropped too low! You may have been told not to even think about cholesterol, that it was a non-issue with HIV, as I've written and lectured many times. Now, there’s no more safe harbor.

It seems that protease inhibitors have caused a few unexpected situations, and this news on Cholesterol is huge! Everyone with HIV should be watchful of cholesterol numbers, especially if taking protease inhibitors. The two numbers that matter the most are "Total Cholesterol" and "HDL Cholesterol," the so-called "good cholesterol." Divide your HDL number into your Total number. This is called the "Cholesterol Risk Ratio". It should not be over four. Five is the American average. Five, or any higher number, should sober up your thought. One of every two people in the United States will die from heart disease. That’s average. Nobody should settle for that -- and here you were, thinking it was HIV that was gonna getcha!

It gets worse. We may hear that Bill had his "first" heart attack at the young age of 45. Bill, I have got some news for you: You are a member of the "lucky half"-- fully one-half of all first heart attacks are fatal. Combined, with our information on risk, these numbers mean that you and the guy on the bench next to you are equally likely to die from heart disease, and if one of you gets a heart attack and lives, that person is a member of the "lucky half" -- there’s someone else that just died from their first heart attack. A client this morning had a ratio over 10! (I’m not making this up!)

So now, instead of a client log of people living with HIV, I have a log of people with significant cardiovascular risk who are also HIV-positive. This affects diet hugely! And dietary FAT is the bottom line. In the past it was OK once in awhile to pig out on junk food (oops, I meant fast food); now it could be deadly.

Less than half of the cholesterol we eat is absorbed into the bloodstream and accounts for only 20% (at most) of all blood cholesterol. On average, about 80% of our collective blood cholesterol is manufactured by our livers. The human liver makes cholesterol from dietary fat -- particularly saturated fat.

I’ve done a lot work as a cardiovascular nutritionist, and there are plentiful means to avoid taking even one prescription medication for heart health. My strategies are practically all about diet, exercise and micronutrient (vitamins, minerals, and antioxidant) supplementation. The heart-health diet is almost exactly the opposite of the standard HIV diet of the last 16 years. So, I must advise you to take a lot of information you’ve heard or read in the past on HIV-nutrition healthcare, and trade it in on new standards, given the fact that you could be next in line for a high cholesterol reading. Cholesterol in anyone’s blood can clog arteries and cause a heart attack -- HIV or not!

Circulating cholesterol, as noted, is self-made from saturated fat in foods like high-fat meats, fried foods of all kinds, "regular" pastries (cookies, donuts, Danish, etc.) and "whole" milk, including 2% milk. (It’s possible that I may have left out a source or two.) Butter and margarine are both full of saturated fats; but the margarine people have led you on and allowed you to believe that margarine is better than butter -- NOT!

Any product like margarine, with hydrogenated fat, has saturated fat -- that’s what hydrogenation does to fat! So margarine from soy, corn, or even olive oil will be saturated and the infamous trans fats in hydrogenated foods are far worse than naturally-occurring saturated fat in any food. So, my bottom line in the butter vs. margarine debates is to use very little of either, but if you do use bread spreads like these, stay close to Nature; choose butter! Just don’t eat a lot of it.

Actually, some vegetable oils are quite high in saturated fat. These are: coconut, palm kernel and palm oils -- the so-called tropical oils. These are less commonly found now, but it’s still a good idea to watch out for them.

We also have cholesterol-lowering power in other dietary areas. Cholesterol, surprisingly, is a very important nutrient. It is absolutely necessary that each cell in our bodies contain it. Cholesterol provides the raw materials for making vitamin D, hormone manufacture (estrogen, testosterone, etc), and for use in all cells for metabolism. The need for cholesterol is so vital, in fact, that we actually recycle it. Our bodies have a cholesterol recirculation system "entero-hepatic recirculation." (Use that one to impress your friends.) One of the most common causes of blood cholesterol build-up is exactly this: recycling is too efficient. But we can out-do Nature here. We can get cholesterol to exit our bodies (and into the plumbing) by "gumming up" the bowel and creating a sticky environment in the intestinal canal -- no recycling possible!

Fiber can help. Fiber doesn’t always appear to be "fibrous." Since dietary fiber is defined as "any food or substance that isn't digested or absorbed by the human intestinal tract" even chewing gum, if swallowed, would qualify as fiber! Oat bran and other soluble fibers, help to prevent the recycling of cholesterol. In fact, some soluble fibers actually are gums (e.g., carrageenan, guar or locust bean gums). Oat bran does just this, and is highly effective for lowering cholesterol. . Other sources include oatmeal, barley, corn and rice brans, and the mushy insides of legumes (beans, peas, lentils), apples, bananas, pears and peaches. These provide a huge bonus if you happen to have diarrhea -- poop gets sticky too and can have you depositing painless, nicely-formed stools.

In summary, dietary cholesterol, as stated, isn't well absorbed. Your choice of diet can impact your blood cholesterol two main ways: Less fat, and enough soluble fiber. Other reasons for high blood cholesterol levels include stress, smoking, and a sedentary lifestyle. You can take meaningful steps today to minimize your personal risk profile by carefully managing your diet and lifestyle.

As you go shopping, take your reading glasses along, and look at ingredient statements. If hydrogenated oils are listed, make sure you think of them as being a death-threat. We must also be pro-active enough to inquire about it with our doctors-- they, just like nutritionists, are trained to not worry about cholesterol since it’s always been a non-issue with HIV. New information is not always happy!

The second main new class of PWAs are those who are "getting sloppy." This includes those who are joyfully watching protease cocktails make magic by getting viral loads down and CD-4 counts high. And from this false sense of security, becoming a bit lazy about medical protocols -- the meds we’re taking and how we’re doing it! As a group, we really need to get more serious; HIV/AIDS is not, and never has been, a casual disease. So, even though your own numbers may be jumping around in desirable directions, it’s easy to forget the vitamins, minerals, and antioxidant supplements that must be seen as a co-therapy with the meds you get from your pharmacist. And getting sloppy by letting daily fastidiousness slide, is not yet something anyone with HIV can allow to happen.

"AIDS," as I recently read in a newsletter, "is Not Over." And it is now, when things are looking really good, that we need to worry a lot more than our improving numbers would suggest. I’m finding that some positive people are using Crixivan (the most difficult Protease Inhibitor - nutritionally speaking) just any old time, not concerning themselves about the fasting "rule" that goes with Crix. Or, some may be taking it at breakfast, lunch, and dinner, rather than the "every-8-hours" mandate from Merk. Every 8 hours is not three times a day, it’s every 8 hours; set an 8-hour alarm if you have to. Does any reader plan to die from HIV because they disregarded the specificity demanded by whatever protease they happened to be on?

Of course, no reader would want that or they wouldn’t be reading this column, right? Now, since I have your attention, I must make it imperative: Don’t abuse your chances -- there aren’t all that many new drugs coming immediately down the pipeline. And some of the ones that are moving down the pipeline will require "naivete" on one or several AZT-type drugs, protease inhibitors, or NNRTIs like Delavirdine (Viramune) or Nevirapine (Rescriptor).

My best advice on welcoming in 1998 is to honor that time-worn tradition of making a good New Years Resolution. While it’s not mandatory that we do this, it is a good idea for this particular year. Remember AIDS used to be an "always fatal" disease, and now it’s "controllable." So let's not blow it.

Works for Me!

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As always, first do no harm. Should any of this be, or seem to be connected to, adverse health 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.