Being Alive; September, 1996
Jennifer Jensen, MS, RD

The Bathroom Answer

If you are hiv+ and have diarrhea, your best diet is one that contains no fruits, vegetables, whole grains or other "roughage," which can promote diarrhea. We can lose a lot of the nutrition value of healthy food if it just ends up in the toilet. It would probably be easier to just scrape the health food off of the plate directly into the toilet and not make the intestines work at processing it first! On the other hand, if you are hiv+ and don't have diarrhea, the same foods-fruits, vegetables and whole grains-are among your best food choices. So, it depends.

The Protein Answer

Then there is protein, representing one of the most important differences between hiv-negative and hiv+ people. People lucky enough to be hiv-negative need lower amounts of protein than most people realize. Excess protein is not discarded by the body; it makes a lot of excess work for the liver and kidneys, just to ditch the surplus. As a rough estimate, negative people probably require about 60 grams per day. Positive people can require up to three times that amount-often as high as one gram per pound of body weight, up to 180 grams per day. Your own individual level can best be determined with the help of a nutritionist/dietitian specializing in hiv/aids healthcare.

A person living with HIV/AIDS may have problems secondary to just plain old hiv. There's always a threat of liver malfunction resulting from the use of old stand-by hiv meds. And now there's the added risk of kidney malfunction caused by protease inhibitors and other new poly-drug cocktails. So it's important to protect vital organs as well as to get adequate, but not too much protein. It's far beyond casual kitchen science-no longer do-it-yourself-work. Too much protein can be a hazard for these organs, and inadequate protein can deplete overall immune function. Again, it depends.

The Fat Answer

Often weight gain is desirable. For adding pounds quickly there's nothing more effective than eating high-fat food. This is not to suggest that these foods are always the best nutrition choices, but if fast calories are what you need, fat food will do it fastest. Can you tolerate a high-fat diet? For this answer, we must look to the health of your fat-processing organs: The liver (liver function tests), and the pancreas (amylase and lipase tests). Then, there's the intestines-are you malabsorbing fat? For that answer, look to your toilet-before flushing. If you have slippery poop that smells bad and leaves a soapy or slimy layer at the top of the water, you probably can't tolerate too much fat; now you're in the low-fat group.

Most people don't know how to dose fat correctly; most hiv/aids nutritionists do, so seek professional advice. Your own best fat level depends on many variables.

Is eating fat a healthy thing to do? Well, not usually. Will the fat you eat turn into the fat you wear? It depends; it's a matter of calories. The source of calories has nothing to do with their ability to become body fat. Let me explain: We all need a certain number of daily calories for basic energy. Calories are, in truth, just units of energy. If you spend (use) your energy wisely, like exercising, and you don't consume more calories than you actually spend, you won't gain body fat. If you take in too many calories for your daily workload, that energy will probably be deposited on your body as flab fat.

So, the source of the calories has little to do with body fat. The source is everything as to whether calories are "empty" calories. Fat calories are usually empty. A donut, for example, has as many calories as a chicken breast. Each of these foods contributes calories, which are units of energy. And if either one gives you more calories than you need, those calories will become body fat. On the other hand, if you actually need this calorie level, body fat won't happen-the calories will be used to meet basic energy needs. Calories and energy; they're synonymous.

If appetite doesn't happen and you slide into skinny, then add calories to your diet. If you can't seem to eat enough to gain weight, then a fat fix may be a good boost for you, especially if all you need is calories. There is often no nutrient value in food fat. Butter is nutrient free; it's all fat. (Butter is also my favorite food.) If you're at your goal weight, butter can add unwanted pounds. If you're too thin, butter can add desired pounds. It's better to be at your desired weight than to get too thin. Try to eat good-food fat, like avocadoes. They have the same amount of fat as butter, but there are powerful nutrients in avocadoes! Nuts and seeds also fall in the fat-with-nutrients food group. So, have it all; eat enough calories to maintain your own personal best weight. Exercise to make sure you turn extra calories into muscle.

So, food fat may become body fat, or it may become desired added weight, as muscle, when used with the exercise method; it depends!

The Exercise Answer

Do you work out? If you don't, and you find yourself with a little too much "extra" then heed that wake-up call; tone the tummy. If you're too thin, it's time to add weight and buff up. I can't tell you what a miraculous feeling it is to work out and gain muscle. It takes time, but good planning can help. It may actually save time because you may require less sleep than when you were a slug. (No offense intended; I personally am a former slug-we've all gotta start somewhere!) Since muscle is packaged in our bodies along with water, then the water weight will do two things: it will make you weigh more, and it will improve your hydration status.

The Water Answer

Over the many years I've worked in hiv-based nutrition, one thing I've seen is too much dehydration. This is, on its own, an invitation to visit your local neighborhood hospital for a rehydration infusion. If you drink the wrong water, it could be an invitation to that same hospital for diarrhea control. Remember, I'm the one nagging hiv-land about drinking only "safe water" and I regret to say that I'm still not getting my message out in the meaningful way it takes to get people to change their behavior.

I've been doing some water research. As you probably know, in 1993 Milwaukee had a cryptosporidiosis.html">cryptosporidium outbreak. This crisis caused diarrheal illness in over 450,000 residents, sent 11,000 to the hospital, and claimed the lives of more than 100 victims. Since then, there have been water problems in Washington D.C., where water supplies were stalled for several 24-hour episodes, and once in New York where residents were told to drink only bottled water for several days. Crypto is a very very teeny tiny little creature that swims in chlorine bleach, multiplies two-for-one in iodine, and is killed-dead-by heat (145 degrees).

Municipalities, especially Milwaukee, are using ultra micro filtration, ozone treatments, and ionizations to clean up the water messes. Will the water scares go away? Absolutely not; if anything, they'll become more common. Nature makes it happen: Animal dung contaminates high-ground springs and surface soil. Rain and gravity bring the dung remnants to lower ground where contributions are made by other, often different species. Then downhill again, then-etc. Will animal dung get any cleaner? Will animals restrict their movements to port-a-potties? Yes! When pigs fly!

Is your bottle of water safe? Does it really come from where the label says it does? Is the answer to these questions "maybe"? Then here are the facts: Bottled water is only required to meet municipal (tap water) standards. About 20% of tap water can be contaminated. Logic is wonderful: Bottled water has to be 80% good and can be 20% bad! Is this risk OK with you?

What can you do to protect yourself? At home, it's easy. Drink bottled, distilled water. Distilled water is really just captured steam, so that tells you it's already been heat-treated; so much for crypto. You can carry your water wherever you go. But what about ice? What about sodas in restaurants, movie theaters, bars, etc.? How's their ice? How neurotic is too neurotic? Remember, a hospital is not a germ-free environment; and besides, it's not healthy to drink their water either. Suppose the new "compassionate use" crypto drug (NTZ) really works; do you want to take it?

But, what to do when not at home? Like at a restaurant. Order canned beverages like tomato juice, fresh-squeezed orange juice (not from concentrate), milk, beer, wine or coffee/hot tea. Remember, all the extra things you do to avoid drinking tainted water-you'll never know if it prevented crypto or not. But you will know if unsafe water gets you! And it is not worth finding out on your own. You can always bring your own beverage-to restaurants, theaters and sports events. At least, I've never been busted for this. Back to dehydration: I often suggest eating foods high in salt because it makes you thirsty. Then you drink. Safe water. Then the salt helps your body hold onto the fluids you give it. But some people really shouldn't eat too much salt for a variety of reasons. Again, this isn't do-it-yourself nutrition-it depends! Get professional advice prior to avid salt-eating.

The Garlic Answer

There are medicinal foods-they act as immune potentiators. Garlic is one. I'm often asked about taking garlic pills. Even "odorless" garlic may cause that "fragrance," leaving you all alone and highly unpopular in close spaces like elevators. If you're going to stink anyway, why not just eat the garlic? It's cheaper for sure. Baking garlic "bunches" can also be a lot of fun! But if you have indigestion, garlic and other spicy foods may be hard to take and the pills may then be a better choice. So even the wisdom of eating medicinal foods like garlic can depend on a lot of other factors. Never be too far away from your Breath Assure!

The Fish Oil Answer

Another medicinal food part is fish oil from high-fat fish like tuna and salmon (well-cooked please!). Fish oils have been showing immunological promise for over a decade and you can buy oil pills everywhere. They're much more expensive than the original fish-way more! And remember garlic breath? Wait till your friends sniff out your fish oil pills! Eat the fish, ditch the pills. Spend some of that old pill money for real fish when dining out.

Never one to miss an opportunity to mention food safety-fish oils can thin the blood. Pills are more concentrated; they can make blood really thin. Often this is good, but importantly, often it is not. Your own bleeding time is important here, and simple medical tests can provide the best information on your own bleeding time. So, fish may be both a medicinal food and also could cause harm. Ask your doctor. After all, it depends!

The Dairy Answer

Now here's a hot, controversial nutrition topic. According to folk wisdom, either you shouldn't use dairy products or you should. When folk wisdom gets really prohibitive or absolute, that unbending "wisdom" isn't an "It Depends" type of approach. Dairy can often produce serious allergies or reactions. If dairy does not cause problems for you, using these foods (milk, cheese, yogurt) allows more freedom for your overall nutrition program. High in both protein and calcium, dairy products offer seriously good nutritional benefits. Since nutritionists disagree, decide for yourself-if you have a choice.

The Supplement Answer

For vitamin and mineral supplementation, advice may depend more on your advisor than on your condition. I've "come out" on this subject before and nothing's happened to make me change my mind or alter my advice. My recommendations are always based upon the circumstances of a given person at a given time. That's why I don't give specific numbers for the various nutrients. My general advice agrees with that of even the most avid critics of supplementation: it is recommended-if only at RDA levels. But we all disagree on the particulars: which nutrients and in what amounts you should take. If you're working with a nutritionist who recommends RDA levels of supplements, my advice is to get a "second opinion."

The Individual Comment

The nutrition answers I've suggested here point out the need to know answers about you, the individual. Who are you, how are you doing, and what, when and how do you eat? Speaking of individuals, that's exactly what we all are. And that's what makes hiv/aids nutrition such a specialized area of healthcare. Remarkably, there seems to be almost 100% agreement that we are all individuals! That means that no two people are alike. No wonder the individual answers depend on you!

First do no harm. Should the advice in this column be, or seem to be related to any adverse consequences, check with your doctor and/or nutritionist. It does matter!

(Jennifer Jensen, MS, RD, CNSD is in private practice. She offers a sliding scale fee arrangement for hiv/aids clients. Supplements are provided at cost. She always welcomes your call at 310.450.5581, or send e-mail to NutPower@aol.com.)

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