January 22, 2010

January 22, 2010

Welcome to another day in my life. Today is Friday and the end of another work week for most of us. I hope you had a great and safe week.

As most of you know from reading my blog, I have been dealing with health problems recently. After meeting with several doctors, I have had to make some changes in my nutritional intake. I have HIV related wasting so I have to eat more than an average person to just keep my weight even. And when you HAVE to eat all the time, it is very easy to get sick of eating. I know friends of mine with weight problems who are trying to lose weight might be shaking their heads right now. But it can be just as hard to gain weight as it is for other to lose it.

As with exercise, there is no "one size fits all" approach to nutrition. Many people look for a magic pill or a supplement that will fill some unmet need in their body. Others seek out special diets, or go organic, macrobiotic, or vegan.

The best advice is difficult to generalize. Each individual patient will be in a different nutritional status depending on their medical condition (early or advanced HIV) as well as what they eat on a day to day basis.

For those people in overall good health, the same advice healthcare providers give their HIV negative patients applies. Consume calories, fat, salt, and junk food in moderation. Avoid saturated and trans fats. Read nutritional information labels on prepared and packaged foods carefully to look for hidden but avoidable calories, salt, and fat. Limit your serving sizes and consider eating more frequent but smaller meals. Stop eating when you are full (no need to clean your plate just because there is still food on it). If you are overweight or have a high BMI (body mass index), consider increasing your exercise and eating less. If you are underweight, consider eating foods with a higher density of calories per serving such as lean meats and fish in addition to multiple daily servings of fresh fruits and vegetables.

For those people in poorer health, recovering from illness or drug abuse, or with limited resources to purchase the often more expensive foods, dietary advice becomes more challenging. If your clinic or provider offers nutritional consultation with a licensed dietician, seek their advice. People living with kidney or liver disease require special diets, as do those with other co-morbid conditions such as diabetes or heart failure. In general it is good advice for this group to add to a regular diet with dietary supplements such as Ensure or Boost or other high calorie/high density after-meal drinks (but ask your provider before adding these to your meals, especially if you have other medical conditions beyond just HIV). I am also a believer that you cannot ever eat enough fresh fruits and vegetables.

I am asked about nutritional supplements on a daily basis. While there are limited data available, I believe a basic generic over the counter multivitamin is a reasonable addition to eating the right foods. Vitamin supplements should not, however, be used as a replacement for eating properly.

Beyond a basic multivitamin, I do not encourage patients to take other kinds of supplements. It is probably safe to say some or most supplements are relatively harmless when taken as directed on the bottles. However, some things that seem harmless can actually be harmful or downright dangerous.

For example, garlic tablets (often used to lower cholesterol or "thin the blood") have been shown to reduce plasma levels of some protease inhibitors. St. John's Wort (used as a "natural" antidepressant) can also lower levels of protease inhibitors. More concerning are those supplements with effects we do not yet know.

There are literally thousands of websites advertising nutraceuticals and other types of pseudo-scientific sounding products making a variety of claims for improving your health. Most of them tout their own "clinical studies" or even worse, testimonials as to their benefits.

As soon as I read testimonials instead of university-caliber rigorous clinical studies that are FDA and peer reviewed, it is a giant red flag that someone is out to separate you from your money. I believe it was P.T. Barnum who put it best: "A fool and his money are soon parted."

Most of these so called healthy alternatives are very expensive. More importantly, almost none of them are regulated by the FDA to confirm that they contain what they claim, nor are they tested for safety or effect. Some contain herbs and other ingredients that may be imported from countries that do not regulate those industries either. You might be consuming harmful amounts of pesticides, heavy metals, or counterfeit ingredients. My advice is do not ever take one of these products until you have discussed the pros and cons with your provider.

Certain micronutrient deficiencies can be harmful if undetected. Examples include iron deficiency (may lead to anemia), B12 deficiency (may lead to neuropathy), and vitamin D/calcium deficiency (may lead to osteoporosis) . If your provider has reason to suspect you have a micronutrient deficiency, there are blood tests available to confirm it. In those special cases, additional supplements may be necessary to correct the shortfalls. It is important to note that with a good overall diet, most of these conditions are uncommon and will not require extra supplementation.

Lastly, as with anyone else, always wash your hands before preparing food. Always thoroughly wash fruits and vegetables. Use separate areas of the kitchen for preparing meats or other uncooked animal products. Avoid cross contamination by washing your hands again after touching raw meats. Use separate utensils, pots, and dishware for raw and cooked foods.

Those are my thoughts. What about yours? Drop me a line and let me know. This series on wellness will continue tomorrow with mental health.

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

big bear hug,

Daddy Dab