Positive NutritionNishanga Bliss, L.Ac.

Assistant Professor, Acupuncture and Integrative Medicine College

Gastronicity.blogspot.com

DIET AND HIV

Since the advent of highly-active antiretroviral therapy, in areas and populations where there is widespread access to these drugs, the focus of nutritional concerns in HIV has shifted from wasting to lipodystrophy. Lipodystrophy can include elevated total cholesterol, LDL and triglycerides and lowered HDL, as well as fat redistribution syndrome (FRS) in which people experience fat loss from their extremities and deposition in the core of the body, especially the abdomen.

Dietary Fat and HIV

In a study comparing HIV+ people with and without Fat Redistribution Syndrome, no differences were found in intakes of carbohydrates, fats, cholesterol or micronutrients. However, the people without FRS ate more calories, protein and fiber than those who had FRS (Batterham, Garsia, & Greenop, 2000).

HIV lowers cholesterol, treatment tends to raise it.

A 2003 study found that a group of men with average cholesterol levels for their age had reduced LDL and HDL after HIV infection (Riddler, et al., 2007). After three years of treatment with HAART, total cholesterol levels had returned to pre-infection levels, however, LDL, total cholesterol and triglycerides were higher and HDL was lower than average, resulting in a lipid profile associated with higher risk of heart disease and diabetes.

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.

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 www.westonaprice.org/moderndiseases )

What is cholesterol, anyway?

A large study in Northern California found that men with a high risk of HIV infection who had low total cholesterol levels (less than 160 mg/dl) had a significantly greater rate of HIV infection, AIDS and AIDS-related death than those who had normal levels (between 160 and 199 mg/dl) (Claxton, et al, 1998). Another study found that low cholesterol was a strong predictor of death from AIDS (Neaton & Wentworth, 1997). This research suggests that cholesterol is exerting some kind of protective effect, at least around HIV.

The Experiment

For over 40 years, Americans have been involved in a vast, uncontrolled diet experiment. We have been told by the government, 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 our cholesterol intake. This massive experiment was based not on fact or experience but on a hypothesis, known as the lipid hypothesis, which states that fat and cholesterol in the diet raises cholesterol levels in the blood, promoting atherosclerosis, resulting in a higher incidence of heart disease. Since fat has more calories per gram than carbohydrates or protein, it was figured that this diet change would also help us lose weight and might even protect us from cancer.

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.

Carbohydrate intake went way up.

“The low-fat campaign has been based on little scientific evidence and may have caused unintended health consequences” (Hu, et al.,

2001, Harvard School of Public Health).

• 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)

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).

Alternative ApproachesAn study released in July 2008 found that red rice yeast and fish oil supplements coupled with dietary, exercise and stress-management counseling was more effective than statin treatment in lowering LDL, as well significantly lowering triglycerides and excess weight (Becker, et al., 2008). Fish oil supplements alone were also found to be effective in lowering triglycerides in people with HIV (Wohl, et al., 2005).

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

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.

Food and the Immune System

Immune Stressors/Supressors• High glycemic foods:

refined carbohydrates• Rancid/inflammatory oils• Pesticides, chemicals in

food• Excessive alcohol, caffeine,

drugs• Nutrient-poor foods, fake

foods, processed foods in general

Immune Supporters• Omega 3 fatty acid-rich foods• Anti-oxidant rich foods• Probiotic and prebiotic foods• Mushrooms (except white

button)• Pastured/organic/wild animal

foods• Nutrient dense foods in

general

Choose Foods that Fight Inflammation to Prevent Heart Disease, Cancer and More

• Berries, chocolate, tea, coffee and nuts are potent antioxidant 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)

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