Being Alive; January 1994
Jennifer Jensen, MS, RD
First...
Nutritionally (and medically) speaking, the first "food" priority is fluids. That's right! Hydration is our first priority. Believe it or not, up to one half of all HIV-related hospital admissions are for dehydration. Weight loss will often follow, given the nature of hospital life. (Hospitals are also full of sick people who may pose a health risk for HIV/AIDS patients by passing along their germs.)
How does dehydration happen so much with HIV/AIDS? The most obvious fluid losses are from diarrhea, vomiting and sweat. Other fluid losses are less obvious. For example, when muscle is broken down, hydration is lost because water is packaged, in our bodies, with muscle tissue. Lose the muscle; the water goes too.
To prevent dehydration, drink about two quarts per day for "usual" days when there is no vomiting, sweats and/or diarrhea. In addition, replace the more obvious fluid losses by adding to the "two quart" system enough to replace, ounce for ounce, the water that has been lost. It doesn't have to be an expensive drink, just a liquid! A safe liquid.
Water is great for hydration. Water can also be a "food safety" risk. Cryptosporidium and microsporidium, however, may be totally avoidable Opportunistic Infections (OIs) by controlling the type of water we consume. Remember these three words: "Heat Kills Germs." Is all bottled water safe? Your guess is as good as mine. But realize that the water may not necessarily come from wherever or whatever source the bottle label indicates.
What this neurosis on water safety means is that we should not drink water other than boiled or distilled (which is steam from boiling water). If you love your designer bottle, fine; boil the water, then refill the bottle with the same, now guaranteed safe. In restaurants, hot coffee, tea and other hot beverages are safe; iced tea and other drinks with ice are not guaranteed to be safe. Even ice should be made from safe water.
(Just another little note on these two opportunistic microbes: They live happily in bleach, they divide and multiply in iodine and they are killed, dead as a doornail when we boil the water in which they live. Heat Kills Microbes!)
Second...
Once fluids are taken care of, calories are our next concern. Without enough calories for adding/maintaining weight, the water won't do much good; we'll get skinny and "waste" without sufficient calories. The best calorie sources are from fat, since they pack in almost three times more calories than other food types. As to the health of eating food that has a lot of fat in it, if your digestive system doesn't mind, neither do I. If fat is not an option for you (e.g., pancreatitis, liver disease, colitis, malabsorption), the best bet is eating a lot of low- or non-fat, high calorie foods. These are actually very easy to find.
Third...
The next nutrition priority is protein. Science still hasn't given us any "ideal" protein requirements for HIV/AIDS, but one gram of protein (see box) per pound of body weight is probably always sufficient. The best sources of protein are egg whites (well-cooked!), dairy (milk, yogurt, cheese, cottage cheese), and meat (beef, pork, chicken, fish).
Of these, the best for most of us is beef. Right! Whatever you may have learned about the nutritional problems of beef-eating was not written/stated with HIV/AIDS in mind. All nutritionists and physicians know that protein is important; my own judgement is that usually, beef is the best source. The reason is that it contains iron, zinc, and B-complex vitamins, carnitine and other beneficial derivatives that are simply unavailable elsewhere in our diets. Since beef has fat, if you don't digest fat well, you may need to eat chicken/turkey breasts, low-fat fish (halibut, swordfish, sole), and low-fat meats (London broil, roasts, tenderloin).
Fourth...
Vitamins and minerals are essential in everyone's diet. With HIV/AIDS, adequate intake of vitamins and minerals is unconditionally necessary. If you are not taking supplements, you should probably start. If you are already taking supplements, make sure that what you're taking is well balanced and recommended with HIV/AIDS in mind. Many dietitians and nutritionists are qualified to provide good advice to avoid over-consumption, which could be risky, and to ensure sufficiency. Don't base purchase decisions on bottle labels; they can "trick" us by using words like anti-stress, "immune-boosting," "high protein" and other come-ons. Get good advice from a qualified expert.
I receive lots of calls about supplementation, and have prepared the following guidelines to help to make sense of the pill maze that may exist in your health-food store or pharmacy.
- The RDAs (Recommended Dietary Allowances) do not take into account the increased needs in HIV/AIDS nutrition healthcare; thus these may not be useful guidelines.
- The various, related B-complex vitamins are often sold as a "balanced" formula of some multiple of milligrams, 25 mg, 50 mg, 100 mg, etc. I suggest an upper limit of 100 mg for this type of supplement.
- Special characteristics of vitamin B12 seriously interfere with its absorption. Either injections (which can be self- administered) or sub-lingual B12 (dissolves under the tongue) is recommended.
- For vitamins A and D, the level of twice the RDA, or 10,000 IU and 800 IU, respectively, is appropriate; beyond this, safety cannot be guaranteed.
- "Someone with something to sell cannot be objective." If your nutritionist or other supplier is advising you and selling to you, that person may have lost objectivity because of the profit to be made (normally, manufacturers' suggested retail prices are twice the vendors' wholesale costs).
- In California and other states, nutritionists are not licensed or defined; thus, no particular requirements exist. This means that anyone who lives in these states can practice as a "nutritionist" without breaking the law. Find out by looking for the initials RD (Registered Dietitian) following a nutritionist's name; those of us who have earned this credential always display it. It's good if the dietitian also has added credentials such as MS, MPH, PhD, CNSD, etc.
- So, look for knowledge, education, background, and experience, in the absence of state regulations. But, there are lots of fake degrees out there. The only state in the country where it is illegal to use credentials from mail-order diplomas is New York.
- If someone claims to have impressive academic qualifications, it's never inappropriate to ask where they went to school. If the answer is a small, unknown, or unaccredited "university," the diploma could be worthless. (I'm proud to have gone to UCLA home of the mighty Rose Bowl-bound Bruins!)
The new New Years Resolution that I suggest, is to establish a "first things first" approach to nutritional hierarchy a well-advised-but-belated nutritional New Years Resolution.
"Nothing Works Alone." A good nutritionist can help you determine what you need, avoid what you don't need, and help everything else work better together. Another message: Medical attention doesn't work alone; without attention to nutrition, it also is incomplete.
With this in mind, a review of my suggested priorities: Without fluids, calories won't work well. Without calories, protein won't work well. And without vitamins and minerals, the calories, protein and fluids are not going to be able to do their work in helping metabolize the other three. I guess three more words may be good to memorize: Nothing Works Alone!
Naturally, should following this advice be, or seem to be, connected with adverse health consequences, consult your dietitian/nutritionist for professional advice.
(Jennifer Jensen, MBA, MS, RD, CNSD, is in private practice. She offers a sliding scale for HIV/AIDS and welcomes your call at 310.450.5581.)
Table 1 can help you regulate the protein in your diet:
Table 1.
| FOOD | GRAMS OF PROTEIN |
|---|---|
| Milk | 8 grams per glass (8 oz.) |
| Yogurt | 8 grams per cup (8 oz.) |
| Soft frozen yogurt | 9 grams per 8 oz. |
| Cheese | 7 grams per 1 oz. |
| Cottage cheese | 8 grams per 1/4 cup |
| Meat/fish/poultry | 7 grams per oz. |
| Tuna/canned salmon | 7 grams per 1/4 cup |
| Eggs | 6 grams each |
| Breads and grains | 3 grams per slice or equivalent |
| Tofu | 7 grams per 3 ozs. |
| Vegetables | 2 grams per 1/2 cup cooked |
| Legumes: | |
| Kidney beans | 8 grams per 1/2 cup cooked |
| Garbanzo beans | 7 grams per 1/2 cup cooked |
| Lentils | 9 grams per 1/2 cup cooked |
| Green peas | 4 grams per 1/2 cup cooked |
| Peanut butter | 4 grams per Tablespoon |
Copyright © 1994 - Beings Alive. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used. Subscription lists are kept confidential. Being Alive, 621 N. San Vicente Blvd., West Hollywood, CA 90069, Tel - 310.289.2551; FAX - 310.289.9866; Email: BeiAlive@aol.com http://www.beingalivela.org/
This information is designed to support, not replace, the relationship that exists between you and your doctor.