April 18, 2012

April 18, 2012
Outsmarting HIV with Healthy Eating

Welcome to another day in my life. Today is Wednesday and we have almost made it through the middle of another work week. I hope you are having a safe and great week so far. It is another busy week for Dab the AIDS Bear and me.

This is going to be the first of three blogs on HIV and nutrition.

Everyone should eat healthy to avoid different health problems but this is especially important for people living with HIV and AIDS. Living with a chronic illness like HIV can present certain nutritional challenges. Without effective HIV medication treatment, replicating virus can tax the body, destroying lean body mass and impairing immune function and quality of life.

While this destruction of lean tissue can be controlled with effective HIV antiretroviral combination therapy, other challenges like fat accumulation and increases in lipids (cholesterol and triglycerides) and/or insulin resistance may arise in some patients after treatment initiation. Although limited research has been done on the effects of nutritional approaches on pre- and post-HAART (highly active antiretroviral therapy) metabolic issues, general suggestions can be extracted from studies regarding other conditions like diabetes, cardiovascular disease, and obesity. These suggestions are aimed at helping the body deal with the effects of HIV or its medications on metabolism, body shape, and quality of life as we live longer with HIV.

Mixing carbohydrates with protein, fiber and good fats is one way to reduce their problematic effect on blood sugar and insulin.

The components of whole food.

Foods are made up of many different components—some are "micro" or smaller quantity nutrients, like vitamins, and some are "macro" or larger quantity nutrients. The three macro groups that compose the majority of our diets are carbohydrates, proteins, and fats. These three units are the basic materials that fuel our activities and metabolism and maintain body composition. Selecting the best sources and amounts of these three macronutrients may help to minimize metabolic disorders (such as high cholesterol and blood sugar) and prevent loss of lean body mass and accumulation of body fat.

The best carbohydrates.

Carbohydrates provide our body's main source of quick energy. After carbohydrates are digested and after some processing by the liver, they are released into the bloodstream as a sugar called glucose to be delivered to the cells.

Throughout the majority of the last million years of our evolution, the human diet consisted of animal carcasses, some seeds, nuts, and fibrous vegetable and fruit carbohydrate sources that are generally nutrient-rich with lots of water, but are not calorie-dense like processed foods of today. The majority of these carbohydrate sources are vegetables, leaves, roots, and fruits (all rich in fiber). Because vegetable fiber tends to slow down digestion, a majority of the carbohydrates in these foods are absorbed relatively slowly, inducing less blood sugar (glucose) and insulin spikes than processed sweets that contain no fiber. Some people call these "slow carbs."

It was only after the advent of agriculture that human beings were introduced to higher intakes of grains as carbohydrate sources. Higher intakes of grains deliver lots of calories. Additionally, some grains deliver their sugar energy relatively quickly, especially if the grain is milled (which removes the fiber that slows down sugar absorption), as are the grains in breads and pasta. Unless you are very active and exercise enough to metabolize nutrients more rapidly, this quick glucose release into the bloodstream can create a dysfunctional hormonal environment that can ultimately promote obesity, cardiovascular disease, and diabetes. This hormonal shift also has a profound effect on lean body mass and fat metabolism, and possibly immune function. The key hormone involved in this problem is called insulin, produced by an organ called the pancreas.

Insulin and insulin resistance.

The hormone insulin is produced by the pancreas to control blood sugar and store it in muscles for later use as glycogen. Insulin's main job in the body is to promote the delivery of sugar energy as glucose to cells. When a small amount of glucose is delivered into the bloodstream, a small amount of insulin is produced by the pancreas to accompany it. When there is a large amount of glucose, the pancreas works to produce a large amount of insulin to facilitate its delivery so that cells can take in as much glucose as possible. Extra glucose that cannot be taken in by the cells circulates in the bloodstream and can be toxic to brain cells, so under normal circumstances, most of it is soon converted into triglycerides (fat) in the liver to be stored for later use. But we have to be careful with high blood levels of triglycerides, since they are what feed fat cells.

The correct amount of carbohydrate sources will provide enough sugar to give a healthy amount of glucose to the cells, but not too much at once. Thus, levels of glucose and insulin in the bloodstream are not unusually elevated for any long period of time. The pancreas works, but it is not overworked trying to keep up with an unusual demand for insulin. However, in the U.S., much of the diet consists not only of large amounts of high-calorie carbohydrate sources, but also of carbohydrates from sweets and sodas, which are very concentrated sources of sugar. The net effect that intake of these calorie-dense carbohydrate foods creates is a bloodstream that is occasionally flooded with large amounts of glucose, a pancreas that is overworked, and large amounts of insulin and triglycerides circulating in the bloodstream. Note that excess insulin causes increased production of cholesterol.

Over time, these occasional glucose, triglyceride, and insulin floods can cause a decrease in the sensitivity of the cells' response to insulin, which reduces the cells' ability to take in glucose. Insensitivity to insulin is called insulin resistance, and it is a serious consideration in HIV because we are now seeing it as one of the core components of lipodystrophy and metabolic problems. Some HIV medications can worsen insulin resistance, so we need to be aware of nutritional considerations that can help. Ways to decrease insulin resistance are to exercise, choose more metabolic-friendly HIV medications, and follow a proper diet. For instance, a prominent study from Tufts School of Medicine found that HIV-positive people consuming an overall high-quality diet, rich in fiber and adequate in energy and protein, were less likely to develop fat deposition.12 This is why it is best to select the majority of your carbohydrate intake from fiber-rich, slow-releasing carbohydrate sources that do not contain an excessive amount of calories. And these good carbs should be accompanied by good sources of protein and fats.

Hope you have a great hump day!

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab