(AUTHOR'S NOTE: At least 1 in 200 Americans is estimated to be HIV-Positive. This number is used here. Also, this article is about suitable nutrition principles for most people with HIV/AIDS. If you have any doubts as to your own situation, contact your nutritionist or physician.)

Developing a Positive Diet

Usually, when health-seeking Positive People change their diets, they tend to follow widely published dietary guidelines for health improvement and disease prevention. It’s not at all difficult to turn to the "popular press" and find dietary advice for prevention of common deadly disorders like heart disease and cancer. Of course this type of information is important -- cancer, heart disease, and stroke are the three leading causes of death in the United States (the fourth is AIDS).

Prevention diets for these maladies is very important, but with HIV there's historically often little risk of them, except for immune-related cancer like Kaposi's Sarcoma (KS) and some lymphomas (glandular cancers). But now, with protease inhibitors sometimes driving up cholesterol numbers, there’s some need for HIV-specific cholesterol-lowering advice. While it’s easy to find information on cancer-nutrition, and cholesterol-nutrition, you probably won’t find advice that incorporates these with the specific needs for apropriate HIV-nutrition.

Remember, the vast majority of Americans are HIV-Negative. The only place you'll get HIV-specific and current nutrition advice is from magazines like Arts & Understanding Magazine, or newsletters from well-established HIV/AIDS information organizations like Project Inform in San Francisco, Treatment Issues by GMHC in New York, Being Alive in Los Angeles, and so on. I’ve been asked several times to write a book on HIV nutrition. But the science of HIV (medications and knowledge of body abnormalities) changes so frequently that a book would be outdated before it ever got to press! Here’s just one example. Until the advent of protease inhibitors, HIV healthcare workers have worried about cholesterol levels only if they dropped too low!

In my private practice, I’ve seen cholesterol totals as low as 86, a really low lab level! As a reference, for Negative Normals we want to see total cholesterol numbers to be under 180 and we really worry if the report reads 220 or higher. Now, as I check over labs for my protease clients, I’m seeing up to 250 and higher(!), even though dramatically lower labs from long ago reside in the same person’s chart. In fact, when I first wrote a version of "Upside-Down Nutrition" in 1994, I made the comment that "Cholesterol is the last thing to worry about for Positive People." My how things can change!

Obviously, I can’t say that now. And that’s why I have said "no" to would-be book publishers. I think everyone communicating information to an HIV-Positive audience has to be extremely current with their information, or it could cause harm. And harm in healthcare is not acceptable. Also, when I am asked to recommend a good book on HIV nutrition, I have to say that if there is one, it'll be out of date the moment the presses start rolling. Instead (or at least, in addition to any book), I recommend reading the current monthly newsletters and magazines. And read them each time they come out (so to speak), to make sure that what you think is right, is right. As science brings us closer to expecting to celebrate future birthdays and things like that, we have to look at the things that these new scientific findings do to our overall picture of HIV and its many devious ways. Maybe I’ll write a book about cholesterol!

Before I get into exercise, I want to make a very important point. Calories are units of energy. We all need a certain number of calories each day just to lie in bed and watch soap operas or other worthy television programming. Anything we do that is physical, like taking out the trash, petting the cat, or lifting your fork to your mouth, increases the number of calories you need, because you used energy in the trashing, petting and eating processes. So, calories are energy, and these two words mean exactly the same thing. Think of this as you read these little exercise advisories.

Heart-healthy aerobic exercise, the kind that makes you pant and sweat (cycling, running, stair-mastering), while important for everyone's health program, is not our primary priority. Rather than burning up loads of calories (spending energy) the HIV priority is to first emphasize muscle-building exercises like lifting weights and other resistance work. These exercises don’t require the panting and sweating energy demanded by aerobic work. That’s because burning calories for exercise, especially if you don’t have well-developed muscles, might cause you to lose weight. And most people I know with HIV need to gain weight (as muscle) and only then, do the aerobic work.

Weight comes in several types. For simplicity, let’s just look at fat weight and muscle weight. The Positive kind of weight to wear is in our large muscle groups: arms, legs, shoulders, abdominals, etc. These muscles, if well developed, will do quite a bit for good health -- you’ll weigh more, yet look the same, because muscle is heavier than fat, and (importantly) you’ll be better hydrated because body-muscle is stored with water.

Also, if you simply can’t eat enough calories to maintain your weight, another perverse HIV-body trick kicks in. And a trick it is indeed! A Positive body will break down muscles for instant energy. Body muscle is the Positive calorie reserve. If Negatives don’t eat enough to maintain their weight, their body fat is where their bodies will go for needed energy. Body fat is a Negative’s calorie reserve. Bottom Line: A Positive body works the opposite way that a Negative’s works. Positively emphasize resistance work first, for that important energy reserve -- get buff. Once you’ve developed good muscle stores, it’s time to begin higher-level aerobic work. That’s why I call it upside-down!

What everyone reads and hears about is diet and exercise advice for middle-class, "Norman Rockwell," America. We hear, for example, that a diet high in fat, particularly saturated fat, is truly bad because it raises blood cholesterol. The HIV/AIDS counterpoint is that saturated fats like medium-chain triglycerides (MCTs) can be the perfect fat type for us -- and MCTs are totally saturated! Coconuts are full of MCT; in fact, their milk and flesh are almost all fat and it's 97% saturated! A heart patient could have a coronary just looking at coconuts! MCTs enhance both protein and fat absorption and are "perfect" for HIV. Upside-down again! (Here's another place where the use of protease inhibitors may cause us to modify this strategy in some cases. That could mean upside-down is upside-down, and that could mean right side-up!)

HIV-Negative Americans are, in general, seeking weight loss. There’s no question about that. And to eat a lot without consuming too many calories, the common green salad is wonderful; it’s nearly calorie-free, it takes a long time to eat, and it pre-loads the stomach to make everything else fill it faster. Hunger, then, goes away without undue pain and suffering.

For Positive Americans, the common leafy salad contains"roughage" for promoting easier, quicker bowel movements. Just what most Positives don’t need! Upside-down again!

There's still that 1/200 Americans who generally don't need or want to lose weight. Lettuce (including Romaine) has almost no nutrients. It gets worse. Lettuce packs in water, holding the fluid between it's plant cell walls, as described above. This watery appetizer, which gets squashed when you chew, can contribute to the "feeling-full-too-fast" syndrome -- good for Negatives, not so good for Positives. It’s something like drinking a glass of water before you eat. And those plant cells are pure roughage -- enough to make a bad case of diarrhea worse, or maybe cause a good case of diarrhea for those lucky enough to not have it. Also, salads do take time to eat, and appetite may not outlast the appetizer.

You've heard of "empty calories"? A salad is "empty food"! Pour your salad dressing over some french fries -- now that’s meaningful food! So we have salads; good for the majority, not good for those of us who are not constipated! Upside-down again!

But there's an even more important, and probably less well recognized problem with salads: Hard-to-clean salad greens! (Ms. Food Safety strikes again!) No matter what you do, or how hard you try, you're not going to get those greens totally clean. Healthy immune systems are fine with a little dirt; unhealthy ones are at risk. And for eating out, perhaps a machine washed the lettuce well, but servers handling the lettuce may only wear those little plastic gloves when in public; behind the scenes, who knows? Actually, I do. I worked as a waitress throughout my college career. What does go on behind closed doors -- you really don’t want to know! Take it from me, it’s not a highly safe food environment. Worse yet, you’ve probably been to a salad bar where there's a plate of glass to shield the buffet from your breath -- they're called "sneeze-guards" for a reason! Don’t take this risk; it’s too much. Order from the menu!

Salads gone, let's take on "the beef." There are some outstanding nutritional benefits in the meat group, red meat in particular -- for HIV/AIDS nutrition, that is. The heart-risk patient would be told to eat less red meat and more white-meat chicken. That's exactly what I would tell a Negative client with high cholesterol. But remember, with HIV, cholesterol is only risky when it's too low separating HIV/AIDS (1/200) from the majority (199/200) of Americans. Upside-down again and again! (Remember the protease disclaimer above, though.)

The reason that HIV-negative America is told to eat less meat is because of the fat and cholesterol. For this the no or low red-meat "rule" was devised. But for HIV/AIDS, red meat is not only a good protein provider, it’s also a natural way to acquire iron, zinc, vitamin B-6 and other vital nutrients -- packaged by mother nature who knows all . . . In fact, even beef liver, really high in cholesterol, minerals and B-vitamins, is very low in fat and another good food choice for the Positive diet. You don’t like liver? Have you tried Pate? Maybe liver just has to be made right.

An HIV nutrition handbook I just read warned against all kinds of meat, pork in particular, relating to Kosher-style dining. I have no quarrel with Biblical laws; they were very important when they were established. However, I must point out that pork is our very best source of vitamin B-1, (Thiamin), necessary to digest carbohydrates. And with a recommended starch (carbohydrate) intake at about 60-70% of all food eaten, this vitamin is truly important. Naturally, supplements can provide for our B-1 needs, but I like to get the real goods as Nature packages them; I thing they work better that way. Yes, Thiamin is available in other foods -- but it's awesome in pork!

Since those old pork rules had mainly to do with food safety, I'll just grab another chance to warn everyone (regardless of HIV status) to cook food well. Since heat kills germs, and modern refrigerators prevent spoilage (aka "oxidation," a different article), all that is necessary to avoid food-borne infection is to cook food very well-done, especially ground meats where every morsel -- not just the surface as in a steak -- may carry deadly bacteria. Just remember three words: Heat Kills Germs!

Then, there's the much-maligned Egg. Long out of favor in U.S. diets because yolks are full of cholesterol (whites are cholesterol free), eggs are invaluable for the diet geared toward the needs of HIV/AIDS. Since egg yolk cholesterol is no longer bothersome, let's consider the white: Pure protein, and one standard by which all other proteins are judged. My advice: "Eat eggs" (well cooked, please!).

Having dispensed with salads, red meat, liver, pork, protein sources and egg conflicts, let’s tackle just two more items in the "Norman Rockwell" diet. How about fiber? Since the American public eats only about 11 grams of fiber per day, but is advised to get from 30-40 grams/day (to prevent heart disease and some cancers), the high-fiber diet is heavily promoted amongst healthcare professionals.

Sometimes, as with salads, that fiber may not be such a good idea, due to diarrhea. But, remember, 199/200 Americans want and need more fiber -- they tend to be constipated! Package labels are not only informative, they're downright boastful on the fiber content. Avoid high-fiber foods if diarrhea is a concern. Here again, it's upside-down on the advice for the public (increase fiber) as opposed to advice for that special 1/200th person (decrease fiber). Upside-down again! And again, and again!

____________________________

First do no harm, as always, if anything in this article is, or seems to be connected to adverse consequences, check with your doctor or nutritionist. The advice in this column is not geared toward heart patients.

_____________________________________

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, Arts & Understanding Magazine, Seattle Treatment Education Project (STEP)and other newsletters.