Being Alive; April 1997
Jennifer Jensen, MS, RD

First: Fluids

Perhaps surprisingly, our first Nutrition Power priority may be fluids. That's right! Still, up to half of hiv-related hospital admissions are for dehydration. Weight loss will follow, given the nature of hospital living. And it's widely suspected that a hospital isn't exactly a germ-free environment.

How does dehydration happen so much for Positive People? The most obvious fluid losses are from diarrhea, vomiting and sweats. Other fluid losses are less obvious, such as when muscle fibers break down. Muscles are packaged in our bodies with water, so when they are broken down, hydration status may suffer. Another non-obvious method of dehydration is when we find ourselves in a hot, dry climate. Here, we could be sweating without knowing it-our moisture (what a good word for sweat!) is on the move and evaporates so we won't feel sweat happening. Nature and her trickery.

To prevent dehydration, drink at least two quarts of fluid per day-a good maintenance method. And when we have one of those "special" days where lots of fluids are lost, the requirement is urgent to replace these obvious losses by adding enough fluids (over the 2-quart minimum) to replace, ounce for ounce, drop for drop, all that has been lost.

What to drink? Ideally we should turn to a dedicated rehydration beverage, a wide range from infant fluids to gator drinks. With hiv so much of a fluid intake is necessary, that we'll likely get to the right fluid balance from most of the more "general" fluid sources; just drink from a variety of choices.

Here's a trick that's kind of sneaky. Work out (resistance exercise) enough to add on muscle. The new muscle will be packaged with water-which will improve overall hydration.

While on sneaky tricks, here's another: Eat salty foods like chicken soup, crackers, or pretzels. The salt will make thirst happen, we'll answer to the call by drinking, and that salt will then help hold onto fluids-women have been water-holding for generations!

Second: Calories

Once fluids are taken care of, calories are our next concern. The most generous calorie sources are from fat-it packs in almost three times the calorie-count from either protein or carbohydrates. As to the health of eating high-fat foods, look to the specifics in other areas of your food plan. If there is balance happening, the extra fat load may be a real plus for calorie gathering activities.

If fat is not an option for you (e.g., pancreatitis, liver disease, malabsorption), the best bet is eating a lot of low- or non-fat, high calorie foods. These are surprisingly easy to find. As an example, notice the very low- and non-fat pastries at your healthfood store or supermarket. Their serving sizes are pretty small, so they can really pack in the calories for very few bites. Are these "health foods"? No! But they're high-calorie foods, and this section of priorities, after all, is about calories.

Third: Protein

Our next nutrition priority is protein. Science still hasn't given us any perfect protein estimates for hiv, but one gram of protein per pound of body weight is almost always a safe bet. The best sources of protein are eggs, dairy (milk, yogurt, cheese, cottage cheese), meats (beef, chicken, fish), and legumes like beans, peas and lentils. Soy protein is also a big plus here!

Of these, the best bet for Positive People may be beef. Right! What you may have learned about the nutritional problems of beef-eating in the recent past was usually not suggested with hiv in mind. All nutritionists and doctors know that protein is important; my own recommendation turns to beef as one of the best sources. It contains iron, zinc, other minerals, and vitamins that are simply unavailable elsewhere in our diets. Since beef can be high in fat, choose leaner cuts like London broil and roasts.

An ounce of meat, an egg and a glass of milk all come to about 7 grams of protein. Look at food labels and note the protein grams disclosed. Count your grams until you're comfortable with meeting this important goal.

Fourth: Supplements

Supplements are absolutely essential. If you are not taking supplements, you should start. If you are already taking supplements, make sure that what you're taking is balanced. Many dietitians and nutritionists can provide good advice to avoid over-consumption-which could be risky. Also, we're good at ensuring sufficiency-not based just on bottle labels; this is just for good advice from qualified experts.

I receive lots of requests for information 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. First a definition: vitamins and minerals are called "micro-nutrients."

* The Recommended Dietary Allowances (RDAs) do not take into account the enhanced needs required for good hiv nutrition. Thus these may not be useful guidelines. Vitamins, minerals and antioxidants support metabolic activity-and metabolic momentum speeds up a lot with hiv in the Big Picture. This may make a case for increased speed and subsequent extra micronutrient needs.

* The related B-complex vitamins are often sold as a "balanced" formula of milligrams: 25 mg, 50 mg, 100 mg, etc. I suggest an upper limit of 100 mg for this type of supplement. Beyond this, you may be paying for more than you need. Sometimes B-vitamins are included in daily "multiples". Make sure you're getting at least three times the various micronutrient RDA levels, then see a hiv-sensitive counselor to refine this rough estimate.

* Special characteristics of vitamin B-12 seriously interfere with its absorption. Either injections (self-administered) or sub-lingual B-12 (dissolves under the tongue) is recommended.

* For vitamins A and D, both fat-soluble vitamins, the level of twice the RDA is appropriate.

* Generally thought of as self-made by our intestines, sometimes we may lack Biotin (a B-vitamin) and vitamin K. Supplements may be needed to make up for conditions where the intestines have been abused-like with antibiotics.

Finally: Nothing Works Alone

A good nutritionist can help you determine and acquire what you need, avoid or limit what you don't need, and help everything else work better together. Another message: medical attention doesn't work alone either; without attention to nutrition, it also is incomplete.

For a review: 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. Nothing works alone!

Naturally, should following this advice be, or seem to be, connected with adverse health consequences, consult your nutritionist for professional advice.

Jennifer Jensen, MS, MBA, RD is in private practice. She offers a sliding scale for hiv/aids and invites you to call her at 310.450.5581. Or send e-mail to NutPower@aol.com

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