Being Alive; November 1993
Jennifer Jensen, MS, RD

However, diarrhea isn't the only problem of elimination; its opposite, constipation, is also among us and can be easily corrected using elegantly simple dietary strategies. A third problem with elimination is vomiting not always easily controlled with nutrition power, but you might be surprised... And, last, a nutrition problem no one is talking about, "sweats," because it's not usually seen as a nutritional item let me assure you, it is!

Diarrhea/Constipation

These two bowel malfunctions share the same nutritional remedy Fiber! Surprised? It's like this: Fiber comes in two forms, insoluble and soluble, and knowing about each of them is the key to nutritional control of diarrhea/constipation.

Insoluble: The first, insoluble type of fiber we normally think of, is true "roughage" and looks sort of "fibrous." Its major sources include fruits (peel especially), vegetables, and wheat-based whole-grains. Legumes (beans, peas, lentils) have insoluble fiber in the husks. Melon caution: higher insoluble fiber levels than you might think!

The function of insoluble fiber is to "bulk and hydrate the stool." The effect in HIV/AIDS is often to overhydrate, causing runny bathroom events. It's possible that our intestines' way of attacking an invader like crypto or salmonella may be to dilute bowel contents in order to rid itself of the bug. So, in HIV/AIDS, there could be two distinct and highly effective ways of causing diarrhea.

For parasites, medical diagnosis and treatment is recommended (good), but not always successful (not good). At least we can control the roughage (very good!). Avoid fruits, vegetables and whole grains when you have diarrhea.

Soluble fiber tends to have the opposite effect of insoluble; it slows the intestines, creating a smoother-acting colon. Since soluble fiber isn't very well known (and highly underappreciated), I'll describe it briefly. Think of oatmeal; once you get it onto your spoon, it's unlikely to slip off or shake off. Actually, it's also hard to eat off. Imagine what that kind of food does in your intestines, and now you have an idea of how soluble fiber works to ease diarrhea.

Don't stop at oatmeal! Oat bran works just as well, and it tastes kind of like cream of wheat, so a beneficial swap is indicated here. Also, soluble fibers are found in bananas, apples (skinless), white rice and barley. If you can make these grains into your staple starches, you'll be doing incredible bowel control in your kitchen. Pasta and potatoes (skinless) are also very useful.

Rice is one of our most powerful do-it-yourself diarrhea remedies. See the box for a few ways to use rice and barley. The "rice mush" recipe is for diarrhea. Stir rice mush into soups, gravies, stews and hot cereals. If you make protein shakes, add a cup of rice mush to the shake. That makes it a medically important drink, far beyond its nutritional value of giving you protein and calories it allows you to retain them!

Still, there is Ricelyte a recommendation from last March. This "pediatric" product reduces diarrhea volume and replaces lost fluids and electrolytes. It has rice syrup solids (note benefits of rice) in addition a powerful-acting agent.

There were problems with my Ricelyte recommendation last March. First, the product was hard to locate. As of now, all of the Aid for AIDS pharmacies carry it. These include Care-Rite in Pasadena, West Hollywood Pharmacy, Vee's Pharmacy and Capitol Drugs in West Hollywood and Ad Rx Pharmacy, Discount Medical Pharmacy, Px Drugs and Bob's Pharmacy. These folks have been told that this article is going to press. They're ready and able to provide for your Ricelyte needs.

The other problem was taste. While the "mixed berry" flavor isn't bad, it gets boring fast with everyday use; thus Ricelyte's flavor needs to be altered from time to time. I suggest using flavoring agents like Tang, Kool Aid, Crystal Lite and even jello to re-arrange Ricelyte's taste. Ricelyte works use it.

Constipation is the flip-side of diarrhea. It can even be a problem for the same person, on the same day, by altering or cycling on and off. This is the classic case where tight fiber-management is warranted. Anti-diarrheal agents can create a "plug-effect" that feeds this type of cycle. Using nutrition power, you may no longer need these drugs.

Constipation can be just as serious a problem as diarrhea, but is seen less frequently in HIV/AIDS. Constipation can have and cause side effects like painful hemorrhoids and diverticulosis, and it can aggravate a diseased colon (colitis).

To keep a smooth-running system, pull in your nutritional powers using insoluble fibers like wheat germ, high-fiber cereals and grains, and lots of fruits and vegetables. (Don't do all of the above at one time you could bring on a diarrhea cycle.)

Nausea/Vomiting

These two disturbances are lumped together because usually, if we can control nausea we automatically eliminate the vomiting. When vomiting occurs, it's often a very unpleasant "reward" for eating well. We're talking sub-conscious thought. The association between food and vomiting can become a major psychological barrier.

To prevent nausea, first stay away from odors avoid the smell of food especially. Avoiding aromas can prevent nearly all nausea attacks. Since warm and hot foods emit odors, try to eat food cold or at room temperature. If you can remove yourself from odor sources (like the kitchen during cooking), you're more likely to completely control vomiting related to nausea.

If you get a hot meal from Project Angel Food (or other service), have the delivery angel put your meal in the fridge for you to eat later they understand things like that. If a caregiver is cooking for you, stay away from the kitchen during the cooking event and stay away till the aromas are gone. Eat the food cold.

Yes, it's actually OK to eat cold spaghetti, pizza, steaks and hamburgers. (Be sure foods are stored in the refrigerator not at room temperature.) Cold foods don't taste quite like their warmer counterparts (you can't have everything!), but they don't create nausea like those counterparts either.

Some foods are good at quieting nausea. Pregnant women with morning sickness do it all the time: saltines, bouillon, broth, chicken soup, etc. All of these foods are bland, salty and very effective.

It's also wise to avoid hot spices, caffeine and your favorite food when nauseated. Yes. Don't allow your brain to get the idea that you have nausea associated with your favorite food. Save that food for use when your appetite is down; don't create a subconscious food-aversion.

Use of anti-emetics (anti-nausea medication) is useful. As most are aware, marinol.html">Marinol, an appetite stimulant used for HIV/AIDS, is a potent anti-emetic too (as is the case with it's illegal cousin, marijuana, I'm told). Most HIV-docs seem willing to prescribe this for appetite, so you might want to check it out for problems with nausea as well.

Fluid Losses

With diarrhea, constipation, and vomiting, fluids are important. Doctors and nurses estimate that from one quarter to one half of all HIV/AIDS hospital admissions are for dehydration. The last thing any of us needs is an unplanned vacation in the hospital for a completely avoidable problem.

Many HIV-related symptoms involve massive perspiration or sweats. Often, night sweats cause incredible fluid losses, but when you're in the middle of such a miserable experience, the very last thing on your mind is food and nutrition. But, from now on, please remember that you have an urgent need, at that time, for avid re-hydration. Whatever is liquid will do.

With massive fluid losses each day, you may need electrolytes as well. Beyond plain liquids, replacing electrolytes can be done with Ricelyte, Gator drinks, fruit juices and nectars, and broth/bouillon-type fluids. Even 7-Up, Ginger Ale and other sodas work well. Ricelyte, as mentioned, has both fluid and electrolytes.

But if wish, you can make your own rice water/rice mush and use it with any fruit nectar or Gator-type drink from the store. It's an economical runner-up to or alternate beverage compared to Ricelyte.

As to how much one needs to drink each day, the amount necessary will vary with each individual's "output profile" for the day. For example, a day of reasonably quiet bowels, no fevers or sweats, no vomiting that's the day to use as "baseline," or "normal." It calls for your "normal" 2-quart/day schedule. On days of losses from diarrhea, vomiting or sweats, fluid needs could be more than double that of "normal" demand.

The very important thing to remember here is that avoiding dehydration is like avoiding opportunist infections. It's one that's really easy, because it's avoidable with attention and care, but it's life-threatening if unattended.

Prophylaxis against vomiting and diarrhea could also prevent a major causes of HIV/AIDS-related weight loss not retaining food/calories. The medical equivalent might be prophylaxis for PCP.

The Last Word

My professional "bottom line" on eliminating the problems of elimination is control. We all have it, not all of us know how or when to use it, but it's there. Remember Nutrition Power awesome!

Naturally, if following the advice in this or any other column on nutrition and HIV/AIDS is or seems to be related to adverse symptoms or consequences, seek appropriate medical/nutritional help from a qualified professional.

(Jennifer Jensen, MS, RD, has a private practice in Santa Monica. She offers a sliding scale for HIV. She welcomes your call at 310.450.5581.)

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