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exercise and weight maintenance
Aug 23, 1999

What foods are natural and economical while being nutritionally dense for HIV affected exercise crazed individual....currently it's bananas...skim milk...raisin bran....yogurt......tuna....I need new ideas!!! Beans are blah and lean meats.... Need to maintain weight but don't like too much fat content...Have to eat lots to keep muscle.(no more supplements I already take B-50, amino acids,acidophilus when I feel like it, Ester-C, 400 IU E and a multi-vitamin..HELP!

Response from Dr. Hellerstein

I'm impressed by the obvious quality of your thought about diet and the fact that you are keeping up the high level of exercise.

But...you don't want to make a set of rules that are logically impossible to achieve! This will make you crazy.

What I mean is this. There are only 2 sources of dense energy, in the final analysis: fat and sugar. Protein can not really provide dense calories. The supplements that you mention of course do not add calories at all. And you are trying to avoid fats. You could get plenty of calories from complex carbohydrates -- this is how most athletes get most of their calories. But there tends to be a limit to how much bulk the stomach wants to take in, and these foods also tend to become a bit tedious to many people. So the truth is that athletes also usually take in a lot of sweets. There are many forms that sweets can take, of course. Low fat yogurt is an example of a common and rather healthy vehicle for addition of sweet stuff; there are many others.

Is there a problem with eating a high sugar diet? This is a question that still invites debate and involves a lot of uncertainty. Sugar does tend to worsen the blood fats (raising triglycerides and lowering HDL cholesterol levels).Blood sugar itself is usually not raised (even in mild diabetics, interestingly), although insulin levels often rise. The higher triglycerides and insulin levels can be a problem in HIV-positive people, especially if they are on protease inhibitors, which themselves tend to raise triglycerides and insulin. So you might want to be sure what your levels of triglycerides, HDL and insulin are. But it should be added that the intake of sugar by aerobic athletes may be a different story (i.e. perhaps little or no bad effects on triglycerides if exercise is high and the body's carbohydrate stores, called glycogen, are periodically being depleted). The jury is still out on this question.

Bottom line, then: if you want to exclude fats and want dense energy, you'll have to let your sweet tooth out.

The rest of what you are doing sounds terrific!

Marc Hellerstein, M.D., Ph.D.


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