1. HIV WELLNESS SERIES
NELSON VERGEL
OUTSMARTING HIV
WITH HEALTHY EATING
LIVING WITH A CHRONIC ILLNESS LIKE HIV CAN PRESENT are “macro” or larger quantity nutrients.
The three macro groups that compose the
certain nutritional challenges. Without effective HIV medication
majority of our diets are carbohydrates,
treatment, replicating virus can tax the body, destroying lean body proteins, and fats. These three units are
mass and impairing immune function and quality of life.1, 2 the basic materials that fuel our activities
and metabolism and maintain body com-
While this destruction of lean tissue can other conditions like diabetes, cardiovascu- position. Selecting the best sources and
be controlled with effective HIV antiretro- lar disease, and obesity. These suggestions amounts of these three macronutrients
viral combination therapy, other challenges are aimed at helping the body deal with may help to minimize metabolic disorders
like fat accumulation and increases in lipids the effects of HIV or its medications on (such as high cholesterol and blood sugar)
(cholesterol and triglycerides) and/or insu- metabolism, body shape, and quality of life and prevent loss of lean body mass and
lin resistance may arise in some patients as we live longer with HIV. accumulation of body fat.4, 5, 6
after treatment initiation.3 Although limited
research has been done on the effects of THE COMPONENTS THE BEST CARBOHYDRATES
nutritional approaches on pre- and post- OF WHOLE FOOD Carbohydrates provide our body’s main
HAART (highly active antiretroviral thera- Foods are made up of many different source of quick energy. After carbohy-
py) metabolic issues, general suggestions components—some are “micro” or smaller drates are digested and after some pro-
can be extracted from studies regarding quantity nutrients, like vitamins, and some cessing by the liver, they are released into
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2. Mixing carbohydrates with protein, fiber, and good fats is one way to
reduce their problematic effect on blood sugar and insulin.
the bloodstream as a sugar called glucose amount of insulin is produced by the HIV medications, and follow a proper diet.
to be delivered to the cells. pancreas to accompany it. When there is For instance, a prominent study from Tufts
Throughout the majority of the last a large amount of glucose, the pancreas School of Medicine found that HIV-positive
million years of our evolution, the human works to produce a large amount of insulin people consuming an overall high-quality
diet consisted of animal carcasses, to facilitate its delivery so that cells can diet, rich in fiber and adequate in energy
some seeds, nuts, and fibrous vegetable take in as much glucose as possible. Extra and protein, were less likely to develop fat
and fruit carbohydrate sources that are glucose that cannot be taken in by the deposition.12 This is why it is best to select
generally nutrient-rich with lots of water, cells circulates in the bloodstream and can the majority of your carbohydrate intake
but are not calorie-dense like processed be toxic to brain cells, so under normal cir- from fiber-rich, slow-releasing carbohydrate
foods of today. The majority of these cumstances, most of it is soon converted sources that do not contain an excessive
carbohydrate sources are vegetables, into triglycerides (fat) in the liver to be amount of calories. And these good carbs
leaves, roots, and fruits (all rich in fiber). stored for later use. But we have to be should be accompanied by good sources of
Because vegetable fiber tends to slow careful with high blood levels of triglycer- protein and fats.
down digestion, a majority of the car- ides, since they are what feed fat cells.
bohydrates in these foods are absorbed The correct amount of carbohydrate COMBINING CARBOHYDRATES
relatively slowly, inducing less blood sugar sources will provide enough sugar to give a WITH PROTEIN, FIBER, AND FAT
(glucose) and insulin spikes than pro- healthy amount of glucose to the cells, but Protein, fiber, or fat will slow the absorption
cessed sweets that contain no fiber. Some not too much at once. Thus, levels of glu- into the blood of glucose from carbohy-
people call these “slow carbs.” cose and insulin in the bloodstream are not drates, which helps to reduce the rise in
It was only after the advent of agricul- unusually elevated for any long period of blood sugar and insulin spikes. So, mixing
ture that human beings were introduced time. The pancreas works, but it is not over- carbohydrates with protein, fiber, and good
to higher intakes of grains as carbohydrate worked trying to keep up with an unusual fats is one way to reduce their problematic
sources. Higher intakes of grains deliver demand for insulin.10 However, in the U.S., effect on blood sugar and insulin. Ensure
lots of calories. Additionally, some grains much of the diet consists not only of large that every meal and snack you consume
deliver their sugar energy relatively quick- amounts of high-calorie carbohydrate has a mix of these three macronutrients.
ly, especially if the grain is milled (which sources, but also of carbohydrates from But what are the best fats, protein, and
removes the fiber that slows down sugar sweets and sodas, which are very concen- high-fiber carbohydrates sources out there?
absorption), as are the grains in breads trated sources of sugar. The net effect that
and pasta. Unless you are very active and intake of these calorie-dense carbohydrate Fats and oils. There are a number of
exercise enough to metabolize nutrients foods creates is a bloodstream that is different kinds of fats. There is motor oil,
more rapidly, this quick glucose release occasionally flooded with large amounts of there is butter, and there are essential
into the bloodstream can create a dys- glucose, a pancreas that is overworked, and fatty acids. The most important oil to
functional hormonal environment that can large amounts of insulin and triglycerides keep a Honda running right is not the kind
ultimately promote obesity, cardiovascular circulating in the bloodstream. Note that with essential fatty acids (EFAs), but if
disease, and diabetes. This hormonal shift excess insulin causes increased production you want to help your body stay healthy
also has a profound effect on lean body of cholesterol. and your immune system operating at
mass and fat metabolism, and possibly Over time, these occasional glucose, its best, you had better consider getting
immune function.7, 8, 9 The key hormone triglyceride, and insulin floods can cause these EFAs on a daily basis. They are
involved in this problem is called insulin, a decrease in the sensitivity of the cells’ called “essential” because your body can-
produced by an organ called the pancreas. response to insulin, which reduces the cells’ not manufacture them, and must obtain
ability to take in glucose. Insensitivity to them from an outside source, like food or
INSULIN AND INSULIN insulin is called insulin resistance, and it is a supplements. These oils are necessary for
RESISTANCE serious consideration in HIV because we are every critical function in your metabolism,
The hormone insulin is produced by the now seeing it as one of the core compo- including building lean body mass and
pancreas to control blood sugar and store nents of lipodystrophy and metabolic prob- fighting infections.
it in muscles for later use as glycogen. lems.11 Some HIV medications can worsen The main point is that since we need
Insulin’s main job in the body is to promote insulin resistance, so we need to be aware EFAs and other fats for health, we should
the delivery of sugar energy as glucose of nutritional considerations that can help. be getting them in our diets from fresh,
to cells. When a small amount of glucose Ways to decrease insulin resistance are to high-quality sources. A proper diet reduces
is delivered into the bloodstream, a small exercise, choose more metabolic-friendly the amount of starchy carbohydrates while
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3. Recent data have shown that mono-unsaturated fats decrease the risk of certain
cancers, and have an anti-inflammatory effect. Since AIDS is an inflammatory
disease, mono-unsaturated fat intake is a factor in managing AIDS, too.
maintaining a certain amount of healthy best oils to cook with. You can also cook should be careful in their selection of milk-
fats so that there is a different macronutri- with high-oleic sunflower oil, avocado, based products. Aged cheeses and yogurt
ent balance than the old high-carbohy- canola, macadamia, or any oil that is high may be more tolerable for those who can-
drate, high-protein, low-fat diets contained. in mono-unsaturated fatty acids. not digest lactose.
This means striving to get fatty acids from Avoid cooking with oils made from
several sources, the least of which are corn and sesame. These oils contain more Egg protein. Next on the list are egg
the saturated fats in butter or animal fat. omega-6 fats, and less mono-unsaturated proteins. The important thing to remember
Understand that saturated fats are not fats, so they have a higher potential for is that whole egg is probably somewhat
the demons we have been led to believe. spoiling and turning to trans-fats, which better than egg white for lean body mass
When we realize that we evolved getting a are bad for the immune system. Try to growth and overall health effect, because
certain amount of saturated fat from foods avoid any intake of these oils when they the yolk is a rich nutrient source, and its
in the wild, it is only logical that they would are not absolutely fresh. protein content complements the protein
have a place in a healthy diet. One recent Also, choose oils that are minimally pro- in the egg white. Together they are a bet-
study showed that dietary saturated fat and cessed. Most of the clear oils in supermar- ter source of protein.
mono-unsaturated fat were associated with kets are stripped of some of their natural
healthy testosterone production in humans, components to make them more suitable Meat protein. While real food like meat
while EFAs had no effect. So it appears that for sitting on store shelves for long periods often seems to take a back seat to protein
we need a little saturated fat for optimal of time without spoiling. Do not use these powders because of a mindset created
hormonal health. However, most people get stripped oils. When you do cook, do not by slick advertising, professional athletes
far too much saturated fat, which promotes overheat the oil so that it smokes, which know the value of real food related to lean
insulin resistance and metabolic problems, causes the formation of carcinogens and body mass growth. If you do not make real
and not enough EFAs, which are needed for destroys the beneficial fatty acids. food and meat fundamentals in your diet,
healthy cells and immune function.13 you will not grow lean body mass tissue
The other important kind of fat that Avoid margarine, hydrogenated as well. Fish, chicken, turkey, and beef are
we should consciously include in our daily fats, or processed oils. Do your best to vitally important foods, not only because
diet is mono-unsaturated fat, which we avoid processed fats or oils, as they have of their protein content, but because they
get from foods like olive oil. Recent data negative effects on cellular health, overall contain numerous other nutritional com-
have shown that mono-unsaturated fats metabolism, and your immune system. ponents that are important for a healthy
decrease the risk of certain cancers, and Look out for the words hydrogenated and metabolism. The message is: eat real food,
have an anti-inflammatory effect.14 AIDS partially-hydrogenated. These kinds of then supplement food with protein powder
is an inflammatory disease, so mono- manipulated fats probably do increase drinks if you need them.
unsaturated fat intake logically has a place the risk of cancer and heart disease. They Lean red meat is a superior source for
of importance in managing AIDS, too. also weaken healthy cellular immune lean body mass growth and blood-build-
metabolism, which means that they might ing nutrients. These include creatine, car-
Fatty acid recommendations. EFAs increase HIV progression. Lastly, they are nitine, phenylalanine, conjugated linoleic
include the omega-3 and omega-6 fatty also likely to promote high lipid levels and acid (CLA), and heme- (blood) iron, the
acids. Most people get an imbalance of insulin resistance. most absorbable form of iron. And meat,
these two by consuming too small an in general, is less likely to cause allergic
amount of omega-3 fats, which have anti- Protein, food for the immune system. reactions than eggs or dairy proteins, like
inflammatory properties, and relatively too Dairy protein fractions, such as caseine casein and whey. The only caution about
large an amount of omega-6 fats, which (contained in milk curd) and whey, are at red meat is that the high amount of satu-
tend to promote inflammation when out the top of the list of proteins that optimally rated fat most commercial red meat con-
of balance.15 To get more omega-3s, eat feed lean body mass growth. In dairy tains could promote metabolic problems.
more fish, including salmon, tuna, sar- products, the amino acid balances, insulin- So be moderate about including it in your
dines, anchovies, mackerel, rainbow trout, raising potential, and overall growth factor diet and choose leaner meats if you do.
and herring. Omega-6s are contained in content add up to one thing: milk proteins Important details on meat: cooking kills
common vegetable oils, like sunflower, were created to make mammals grow big- bacteria in meats. Stewed meat is better
safflower, and corn oils. Try to reduce your ger. While there is a lot of hoopla related for digestion (chicken soup, beef stew).
intake of these. to which dairy protein fractions are best, Roasting is okay. Try not to fry or barbecue
there is more misinformation than reality with charcoal. Charred foods are associ-
Oils and cooking. Olive oil is one of the in this area. Those with lactose intolerance ated with increased risk of gastrointestinal
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4. Vegetarian or vegan diets present a challenge to people with HIV or AIDS
who need a full spectrum of amino acids and micronutrients. Unless you are
vegetarian for ethical reasons, consider eating eggs and fish.
system cancers. Any cooking of meat or your doctor’s direction. Those who have sugar should be on your radar when read-
vegetable protein that causes the formation liver problems need good protein intake ing labels. Watch this funny video for more
of a hard outer skin renders the protein that for the repair of liver tissue, but should details on healthy eating: www.youtube.
becomes the skin to be much less digest- also be careful about higher protein intake, com/watch?v=peuLPHuvq1Y.
ible because it cross-links the protein. and should also do so only under a doc- Try to eat several smaller balanced
tor’s supervision. (protein + good carbs + good fats) meals
VEGETARIAN DIETS or snacks instead of two to three large
It is very difficult to gain lean muscle CALCIUM AND VITAMIN D—TWO ones. Smaller meals/snacks are more eas-
weight on a vegetarian diet. In fact, it is IMPORTANT MICRONUTRIENTS ily digestible, keep blood sugar and insulin
almost impossible for most people, espe- Bone loss has been reported in several more constant through the day, and keep
cially when they are fighting infections HIV studies. It seems to be caused by the you from binge eating late at night.
that burn lean body mass. While I know effect of the virus on the body. Certain Eat more almonds, walnuts, pecans
a very few HIV-positive people who can medications like tenofovir (Viread) may and pistachios (good cholesterol-lowering
do well adhering to a vegetarian regime, I make this problem worse. We also seem fats). Twice a day, snack on such nuts to
find that the vast majority cannot do it and to have a high incidence of vitamin D get your good fats and fiber. If you wish,
keep their lean body mass. Additionally, deficiency due to potential HIV medication mix them with some dried fruit. Research
vegetarian diets increase the potential for effects or metabolism issues. We know that has shown that people who eat nuts tend
anemia because of a lack of blood-building calcium and vitamin D help to strengthen to have lower LDL cholesterol.
components such as highly absorbable bone. Many of us chose to take calcium Avoid junk and fast food. The best way
heme-iron and vitamin B12. plus vitamin D supplements, but there are to do this is to have enough food at home
If you do choose a vegetarian diet, also foods that are rich in these nutrients. and to bring lunch to work. Cook a lot of
your best protein sources are beans, seeds Calcium-rich foods include milk, cheese, food on weekends and freeze meals in
and nuts. Digestion of nuts and seeds will spinach, fortified orange juice (be careful small containers you can heat up later.
be improved by soaking them overnight with the sugar, though!), fish, eggs, and Do not sabotage yourself by bringing
to reduce the enzymes they contain that beans. Vitamin D-rich foods include milk, sweets and junk into your home. Watch
inhibit digestion of proteins. If you can eat most fish, and eggs. However, most of us your cravings at night, when most people
them without digestive problems, many do not consume the 1000 mg and 2000 IU find it the most difficult to avoid overdrink-
nuts and seeds are ideal foods because needed per day for calcium and vitamin D, ing alcohol or eating ice cream, cookies,
they contain protein, healthy fat, and com- respectively, and need to take over-the- and comfort foods.
plex carbohydrates in a very good balance counter supplements. One word of caution: Eat a large breakfast, a moderate
for overall health. They also make a great do not take your calcium supplements lunch, and a small dinner. Skipping break-
snack between meals. However, the amino with your HIV medications since they may fast makes you more prone to overcom-
acid balances in these proteins do not interfere with their absorption (at least two pensate by eating more calories late in the
appear to be optimum for lean body mass hours before or after is okay). day. Your body has spent several hours
growth for humans. Again, vegetarian or without food and is starved for nutrients
vegan diets present a challenge to people MISCELLANEOUS NUTRITION TIPS in the morning. Do not feed it sugar and
with HIV or AIDS who need a full spectrum If diet, weight loss, and exercise fail to white flour products at this important
of amino acids and micronutrients. Unless lower your LDL cholesterol and triglyc- time. Eggs, oatmeal (the type that has
you are vegetarian for ethical reasons, erides, ask your doctor for a prescription no added sugar, and you can add whey
consider eating eggs and fish. for lipid-lowering agents (statins, fibrates, protein powder to it!), Greek-style yogurt
Caution: People who are on HIV etc.) or to switch your meds to a more with nuts and fiber supplements, low-fat
medications like tenofovir (in Viread, lipid-friendly HIV medication combination. cottage cheese with fruit, almond butter
Truvada, Atripla, Complera, and the Quad), For your food, shop mostly in the on multigrain (high-fiber) bread, and fruit
which may affect kidney function in some outer part of the grocery store where the are all good choices for breakfast.
patients, should be careful about increas- fresh produce, meats, and milk products/ For lunch have some soup and a glass of
ing their protein intake too high (over 1 eggs are. Avoid overly processed canned water first and wait 10 minutes to trick your
gram per pound of body weight per day), or packaged foods, except for frozen body into feeling full faster. Grilled chicken
as this can increase the potential for kid- vegetables. Read the labels and avoid with vegetables, tuna salad over greens and
ney problems. Ask your doctor if you are products with many preservatives and nuts, a Greek salad with sliced steak, and
taking kidney burdening medicines, and, additives. Trans-fats and hydrogenated any Mediterranean food choices are good.
if so, only eat a higher protein diet under oils, high fructose corn syrup, and high For dinner, fill yourself with stir-fried
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5. Consuming sugar daily can affect
your metabolism, create insulin
resistance, make you fat, and
have all kinds of negative health
consequences.
(use olive oil!) vegetables and lean meats. than processed grains, but when they does not mean that you should starve
Two hours before bed, you can have half are milled into flour the difference is not yourself. Hopefully, this information has
an almond butter sandwich or yogurt with that great. The very worst carbohydrate shed some light on healthy food sources
fruit. You will not be hungry and desperate sources are sweets, like candies, which and how they can affect health and the
with this diet! can deliver as many as 2,000 calories per body. Now that we are living longer, food
Eat fruits and vegetables of all pound. Try to eat from the first group of choices can determine how well we do as
colors. Each has a different antioxidant slow-release carbohydrate sources most of we age with HIV. So, take charge of your
profile. The produce section of the market the time, and if you are relatively healthy, health and take care of your body. It is the
is basically a fresh vitamin department and you can have small amounts of milled only one you have. e
a medicine chest. Some foods like garlic, wheat products or sweets once in awhile.
onions, and ginger have genuine thera- Drink lots of water. Six to eight glasses
peutic effects. Eating the widest variety of a day is a good goal. If you get thirsty, you GO TO POSITIVELYAWARE.COM
fresh produce on a daily basis assures you are already dehydrated! for references and an example
of getting all the ingredients that nature Eat a high-protein, complex of a healthy shopping list.
provides that can help keep your body carbohydrate-rich meal after workouts.
strong enough to handle bacteria and Examples: chicken salad with nuts, cottage NELSON VERGEL, a chemical engineer from
viruses so that you stay healthy. cheese or yogurt and nuts/fruit, celery Venezuela, has been HIV-positive since
Avoid sodas, sweet drinks, and fruit sticks and hummus (chickpea butter), etc. 1983, and is a leading treatment advocate
juices (fruit sounds healthy, but juice Manage your intake of caffeine (it on HIV disease. He created the Program for
contains too much sugar and no fiber to reduces appetite but can increase anxiety). Wellness Restoration (PoWeR) and founded
slow down its absorption into the blood).16 Do not have any caffeine after 4 p.m., the Body Positive Wellness Center in
Consuming sugar daily can affect your since it can impair your sleep. Houston. Nelson has lectured extensively
metabolism, create insulin resistance, Minimize hidden sugars like high around the country and overseas, and
make you fat, and have all kinds of nega- fructose corn syrup. Read the labels of with his research partner, Michael Mooney,
tive health consequences. The suggested food you buy. Diet sodas tend to make co-authored the book Built to Survive. In
pecking order of carbohydrate food your brain crave sweets in general, so they 2010, he wrote and published Testosterone:
sources that support your health without are not good substitutes for sugary drinks. A Man’s Guide—Practical Tips for Boosting
increasing insulin resistance follows. Best Water, water, water! Physical, Mental and Sexual Vitality.
are vegetables in their many forms. Next If you do not consume at least 20 He is currently a member of the DHHS
are beans and peas. These deliver more grams of fiber a day, add to your intake Panel on Antiretroviral Guidelines, the
calories than vegetables, but the carbo- supplements like Citrucell or Benefiber, AIDS Treatment Activists Coalition, and
hydrates release much more slowly than purchased in any grocery store. Fiber moderates PozHealth, one of the largest
grains. Next are whole grains, which are improves insulin sensitivity, makes you HIV health discussion listservs online.
calorie-dense but contain carbohydrates feel full longer, keeps your gut healthy Read posts from Nelson’s blog,
that, in general, release somewhat slowly. (friendly gut bacteria that produce “Surviving HIV,” at http://survivinghiv.
At the bottom, and the most likely to vitamins love fiber), keeps you regular blogspot.com/
promote body fat problems, are carbohy- and reduces diarrhea, and can lower the Read Nelson’s blog, “Outsmarting
drates from milled grains, like wheat and chances of getting colon cancer.17 HIV: A Survivor’s Perspective,” at www.
corn. Whole grains are marginally better Eating healthy is eating smart, and it thebody.com/content/art60473.html
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