Nutrition & HIV January 2013 PLUS


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Nutrition & HIV January 2013 PLUS

  1. 1. Positive Nutrition Nishanga Bliss, L.Ac.Assistant Professor, Acupuncture and Integrative Medicine College
  2. 2. DIET AND HIVSince the advent of highly-active antiretroviraltherapy, in areas and populations where there iswidespread access to these drugs, the focus ofnutritional concerns in HIV has shifted fromwasting to lipodystrophy. Lipodystrophy caninclude elevated total cholesterol, LDL andtriglycerides and lowered HDL, as well as fatredistribution syndrome (FRS) in which peopleexperience fat loss from their extremities anddeposition in the core of the body, especially theabdomen.
  3. 3. Dietary Fat and HIVIn a study comparing HIV+ people with andwithout Fat Redistribution Syndrome, nodifferences were found in intakes ofcarbohydrates, fats, cholesterol ormicronutrients. However, the people withoutFRS ate more calories, protein and fiber thanthose who had FRS (Batterham, Garsia, &Greenop, 2000).
  4. 4. HIV lowers cholesterol, treatment tends to raise it.A 2003 study found that a group of men withaverage cholesterol levels for their age hadreduced LDL and HDL after HIV infection(Riddler, et al., 2007). After three years oftreatment with HAART, total cholesterol levelshad returned to pre-infection levels, however,LDL, total cholesterol and triglycerides werehigher and HDL was lower than average,resulting in a lipid profile associated withhigher risk of heart disease and diabetes.
  5. 5. What is cholesterol, anyway?Cholesterol is a waxy substance found in most tissues of the body and manufactured by the liver and body tissues. It is used for tissue repair, producing testosterone, estrogen, DHEA, adrenocorticosteroids (hormones released by the body under stress), and vitamin D, creating serotonin receptors, and producing bile salts. For most people, cholesterol in the diet does not have an appreciable impact on blood cholesterol (Hu, et al). When more cholesterol is consumed, less is produced by the body. In the diet, it is found exclusively in animal products, especially eggs, butter, liver and shellfish.
  6. 6. The Many Uses of Cholesterol• ● Cholesterol is produced by almost every cell in the body.••• ● Cholesterol in cell membranes makes cells waterproof so there can be a different chemistry on the inside and the outside of the cell.•• ● Cholesterol is nature’s repair substance, used to repair wounds, including tears & irritations in the arteries.•• ● Many important hormones are made of cholesterol, including hormones that regulate mineral metabolism & blood sugar, hormones that help us deal with stress, & all the sex hormones, such as testosterone, estrogen & progesterone.•• ● Cholesterol is vital to the function of the brain and nervous system.•• ● Cholesterol protects us against depression; it plays a role in the utilization of serotonin, the body’s “feel-good” chemical.•• ● The bile salts, needed for the digestion of fats, are made from cholesterol.•• ● Cholesterol is the precursor of vitamin D, which is formed by the action of ultra-violet (UV-B) light on cholesterol in the skin.•• ● Cholesterol is a powerful antioxidant that protects us against free radicals and therefore against cancer.•• ● Cholesterol, especially LDL-cholesterol (the so-called bad cholesterol), helps fight infection.•• (adapted from Myths & Truths About Cholesterol - WAPF
  7. 7. What is cholesterol, anyway?A large study in Northern California found thatmen with a high risk of HIV infection who had lowtotal cholesterol levels (less than 160 mg/dl) hada significantly greater rate of HIV infection, AIDSand AIDS-related death than those who hadnormal levels (between 160 and 199 mg/dl)(Claxton, et al, 1998). Another study found thatlow cholesterol was a strong predictor of deathfrom AIDS (Neaton & Wentworth, 1997). Thisresearch suggests that cholesterol is exertingsome kind of protective effect, at least aroundHIV.
  8. 8. The ExperimentFor over 40 years, Americans have been involved in a vast,uncontrolled diet experiment. We have been told by thegovernment, nutritionists, public health experts, the media,and the food industry to reduce the fat content of our diets,to substitute vegetable fat for animal fat, and to reduce ourcholesterol intake. This massive experiment was based noton fact or experience but on a hypothesis, known as thelipid hypothesis, which states that fat and cholesterol in thediet raises cholesterol levels in the blood, promotingatherosclerosis, resulting in a higher incidence of heartdisease. Since fat has more calories per gram thancarbohydrates or protein, it was figured that this dietchange would also help us lose weight and might evenprotect us from cancer.
  9. 9. What happened? Over the past 40 years…• Fat, especially saturated fat intake, has gone down.• Total calorie intake has gone up.• Carbohydrate intake has gone up.• The incidence of heart disease has not changed• The incidence of diabetes has skyrocketed— new diagnoses were up 90% in the past 10 years.
  10. 10. Carbohydrate intake went way up.
  11. 11. “The low-fat campaign has beenbased on little scientific evidenceand may have caused unintendedhealth consequences” (Hu, et al., 2001, Harvard School of Public Health).
  12. 12. • The data on whether there actually is an increased rate of heart disease in people with treated HIV are inconclusive (Calza, Manfredi, Pocaterra, & Chiodo, 2008; May, et al., 2007). However, it is clear that there is a higher rate of diabetes in people living with treated HIV. For example, a 2003 study showed a threefold increase in diabetes diagnoses among women taking protease inhibitors (Justman, et al., 2003)
  13. 13. HIV meds: encouraging pre-diabetes? An Australian study found “a pro- inflammatory milieu equivalent to that of insulin-resistant obesity [which] characterizes lean men with treated HIV infection,” concluding “these factors may contribute to the accelerated diabetogenesis and cardiac risk in treated HIV infection” (Samaras, 2008).
  14. 14. AlternativeApproachesAn study released in July 2008found that red rice yeast andfish oil supplements coupledwith dietary, exercise andstress-managementcounseling was more effectivethan statin treatment inlowering LDL, as wellsignificantly loweringtriglycerides and excessweight (Becker, et al., 2008).Fish oil supplements alonewere also found to beeffective in loweringtriglycerides in people withHIV (Wohl, et al., 2005).
  15. 15. Recommendations• Maintain a healthy weight. If you need to lose weight, research supports refined carbohydrate, not fat or calorie, restriction as the most effective way to lose weight and prevent FRS.• Focus on fat quality, not amount.• Use stable fats in cooking. Animal fats, such as butter, ghee & lard, & coconut, palm, olive & expeller-pressed high oleic safflower or sunflower oil are the least subject to damage by heat.• Avoid deep-fried foods. If you deep-fry at home, use non-hydrogenated lard or tallow as a frying medium.• Increase omega 3 fatty acid levels in your diet by including flax or hemp seeds & walnuts or their expeller-pressed oils, choosing pasture-fed dairy & animal foods and sustainably caught wild fatty fish and eating plenty of leafy greens, and at the same time,• Reduce omega 6 levels by avoiding corn, soybean, cottonseed & non-oleic safflower & sunflower oils, and minimizing the use of grain-fed dairy & animal products
  16. 16. Recommendations, pt.2• Reduce refined carbohydrates (white sugar & most sweeteners & refined grains such as white flour & white rice).• Strive to eliminate all industrially produced trans fats from your diet, found in margarine, vegetable shortening, commercial pastries, deep-fried & fast food, & most prepared snacks, mixes & convenience food.• Exercise regularly.• Increase fiber & micronutrient intake by eating wide variety of fruits, vegetables, whole grains & nuts.• If high cholesterol remains a concern after trying all of the above, consider natural therapies and supplements before resorting to lipid-lowering drugs.• Consider a short cleanse to get you started.
  17. 17. Food and the Immune SystemImmune Stressors/Supressors Immune Supporters• High glycemic foods: • Omega 3 fatty acid-rich foods refined carbohydrates • Anti-oxidant rich foods• Rancid/inflammatory oils • Probiotic and prebiotic foods• Pesticides, chemicals in • Mushrooms (except white food button)• Excessive alcohol, caffeine, • Pastured/organic/wild animal drugs foods• Nutrient-poor foods, fake • Nutrient dense foods in foods, processed foods in general general
  18. 18. Choose Foods that Fight Inflammation to Prevent Heart Disease, Cancer and More are potent antioxidant• Berries, chocolate, tea, coffee and nuts sources, and coffee is the largest single source of antioxidants in the Western diet. Eating a few ounces of dark chocolate a week has been shown to provide numerous cardiovascular benefits.• Other foods that are rich antioxidant sources include dried beans, prunes and plums, onions, and most richly pigmented plant foods.• Consuming celery, onions and garlic, omega 3 and 9 fatty acids, seaweed, fiber, dark chocolate, coffee, and full fat dairy products (Bonthuis, 2010), have all been linked to cardiovascular protection.• Traditional medicinal and culinary herbs are some of the most antioxidant rich foods ever measured, and provide important antioxidant protection in usual dietary and medicinal amounts (Carlsen, 2010)
  19. 19. Check out my book to find out more: