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Q #1: Crixivan Diet
I met with Jennifer Jensen back in 1990 in her office somewhere on the west side of Los Angeles. I am an 18-year survivor of HIV. I was newly diagnosed with HIV back then. My doctor and I determined that I was infected in 1981 or 82. He referred me to Jennifer for a nutrition consult. I was told by Jennifer to eat what I wanted at the time, because I was in pretty good health and my T-cells were well within normal range. In the past month I have gone on medication for the first time. I had an attack of colitis and was hospitalized. My t-cells while this happened went down to 250 and my viral load went from my normal 5,000 to 77,000. I am taking Crixivan and Combivir. I am still having some diarrhea and gas and have not returned to normal. The medical situation here in the bay area of San Francisco is poor to say the least. I've been here two years and feel lost. I was never given any kind of diet to go on after my hospitalization and medication. Even when I asked. I am interested in the best possible diet to get over this and to be compatible with this terrible medicine I have to take now. Can you help? Thank you. (October, 2000)
A: Ken Stringer (Website Administrator) responds:
Jennifer addressed this issue directly in her article Protease Perfection: Flawless Fasting. Of course, the Virtual Faculty recommends that every HIV+ person see an HIV-savvy dietitian/nutritionist for a consult. There are many variables to consider when tailoring a diet to deal with this virus, such as any medications you may be taking, any particular symptomology (nausea, diarrhea, weight loss, lipodystrophy, etc.) you may be experiencing, and, of course, your particular likes and dislikes.
For a good primer on food choices, their pros and cons, you might want to also check out Jennifer's article Pyramid Power.
A:Charlie Smigelski, RD responds:
First of all, I think that Combivir (AZT & 3TC) plus Crixivan is an odd combination. You said that medical care is deteriorating, so you may want to get another HIV doc's input on this. Crix is a dificult drug to take; you must wait an hour to eat after you take it, plus wait two hours after eating to take it again. Also, you must drink 2-3 quarts of water a day along with it to prevent Crix-kidney stones.
Though I'm not an MD, in my experience, a mix of Combivir along with Viracept is a smarter drug combo to start. If resistance mutations develop to the PI/Viracept, then Crixivan can still work as a second move. Crix has many more cholesterol, triglyceride, muscle, stomach, and joint side effects. The major issue with Viracept is diarrhea. A daily dose of Glutamine and some psylium usually solves that pretty well.
Now, a woman starting a protease inhibitor at all is still another issue. Women are more likely than men to have adverse body changes from a protease inhibitor, and have the toxic side effects sooner, like within a month or two. A mix of Combivir and Niveripine/Viramune is a non-PI regimen that a woman might consider. This is one that tolerates no missing of doses, though. Even messing up pills on two weekends of a month may allow resistance to happen. But it is a minimal side effect plan. You must watch for a rash early on, within the first week or two of starting it.
If you stay with your current Crix and Combivir plan, I would take the usual B-complex and anti-oxidant vitamin plan we recommend for every HIV+ person to help supply the immune system with needed materials and to keep oxidative stress levels low:
1. Vitamin C: Take 1 to 2 grams a day.
2. Vitamin E: Take 400 to 800 i.u. a day as "mixed tocopherols"
3. B Complex vitamins: Take a Complex 25 or a Complex 50 to get enough.
4. Selenium: Take 200 micrograms/day of selenomethionine.
5. Zinc: Take 30 mg a day.
6. N-Acetyl Cysteine: Take 1 to 2 grams a day.
7. L-Glutamine: Take 5 to 10 grams a day.
8. Essential fatty acids Take 1 gm of Fish oil and 2 gm Evening Primrose oil to help prevent lipid problems.
9. Beta carotene: Eat this daily, in carrots, spinach, winter squash, etc. You can find an antioxidant multivitamin that contains many of these items all blended together. Jarrow makes one, Trader Joe's does too.
Some other supplesments also important to the liver, and to fat metabolism are:
10. Alpha Lipoic Acid: Take 200-300mg a day.
11. L-Carnitine: Take 1 to 2 grams a day.
12. Milk thistle: Take dose as per bottle. Use only if your liver enzymes are up. It is unclear if milk thistle helps the liver clear HIV drugs out of your body faster.
For food, a decent protein, good fats and modest starches plan is still best. Get protein-starch-fruit-veges-and some nuts at each meal.
Q #2: HIV & Bodybuilding Diet
I have HIV and I bodybuild as well. I have been wanting to obtain a preplanned menu that outlines calories, protein intake, fat composition etc. I would like to consume about 3000 calories per day, low fat (because of PI's) but healthy and balanced that will also allow me to build muscle. I have checked all the bodybuilding resources and nothing really exists except for a rather expensive computer program. I find tables that give individual breakdowns of foods time consuming and confusing. Is there anything that exists that is easy, preplanned (for example, gives a week of menu ideas outlining protein, fat and caloric intakes) and tastes good (hopefully)? Thanks. (December, 1998)
A:Diana Peabody, RD responds:
As Ken has said above, I believe a detailed menu plan should be done in consultation between the individual and a dietitian expert in HIV/AIDS. But having said that, here are some general guidelines for a 3000 calorie-a-day diet plan:
1) 25-39% of calories should be from fat. That's about 85-100 g of fat. Most of the fat should be from healthy oils (canola, olive) and much less from saturated fat or trans fatty acids.
2) 50-55% of calories should be from carbohydrate, or about 375-400 g. Minimize the simple sugars. Choose mostly from whole grains, fruits, vegetables, and legumes.
3) 15-20% of calories should be from protein, or about 115-150 g. Choose mostly low fat sources of meat such as chicken, fish, legumes, milk and milk products. Fish should be eaten 2-3 times per week for a variety of reasons.
For rule-of-thumb measuring, consider that 1 tsp of fat or oil has 5 grams fat; 1 serving starchy food (e.g., 1 slice of bread, 1/2 cup rice, pasta or cereal) has 15 g carbohydrate and 2 g protein; 1 serving fruit/vegetable has 10 g carbohydrate; 1 ounce meat/chicken/fish/cheese or 1 egg has 7 grams protein plus 3-5 g fat; 1/2 cup milk/yoghurt has 4 g protein, 6 g carbs, plus fat.
A diet containing the following would come close to meeting the parameters you set forth:
Protein foods: 7-8 oz
Starchy foods: 15 servings
Milk: 3-4 cups or servings
Fruit/vegetables: 8 servings
Fats: 12-14 servings
That's all I feel I can or should do in this forum.
