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Lipodystrophy help!

Sep 7, 2004

dear nelson, I do not know what to do anymore. This is coming from a young man who was once full of hope and now feels helpless. I have battled hiv for six years, I was started on treatment right away as my immune system had shown moderate progression. i was treated with a d4t combo for a few years, then switched to a azt combo. needless to say, I have developed the "Look". Being a naturally small framed man I have shrunk even more and my fat has shifted from the rest of my body and my ass to my stomach and "love handle" area.I find eating more calories only leads to a bigger stomach with more fat. I have heard about some people trying diets like atkins or the zone, but I am not sure if it is wise to limit my carbs, as i probably need the calories. I also do not have much time to exercise as I am a full time student and part time worker. What could possibly help?

Response from Mr. Vergel

We do not have the whole picture yet when it comes to solutions to lipodystrohy, but I would suggest the following :

1- Wait til we hear more about Sculptra's patient assistance program to get something done about facial wasting, if you have it. The info should be available soon. I will post it on

2- Have your doctor check your testosterone (free and total), estrogen, DHEA and thyroid hormones and supplement any of those hormones if needed. More info on If you have insurance, ask your doctor for Testim (testosterone gel). If you do not have insurance, you may want to get a compounded gel made by (they have the cheapest testosterone gel out there)

3- Eat a lot of soluble fiber by consuming these foods: Apples Barley Brown rice Currants Dried beans Figs Fresh peas Methylcellulose (Citrucel) Oat Bran Oatmeal (sugar free with fruit) Pasta Prunes Psyllium husks (Metamucil) Raisins Wild Rice

4- Do not eat three big meals a day but 6 small ones instead. Snack instead of feeding yourself like most americans who eat small breakfats and bigger lunches and dinners. Eating frequent smaller meals with all food groups (never eat a food group alone except fruit) keeps your insulin levels more constant and my improve insulin sensitivity (the way your body uses insulin to store energy in your muscles and liver). Insulin resistance has been linked with fat build up in the belly.

5- Work out with cardiovascular and resistance exercise 3-4 times a week. Work out with weights and machines for 45 minutes followed by 20 minutes of cardio ( I love the elliptical trainer machines at the gym)

6- Keep your cholesterol and triglycerides in normal range with supplements like Omega 3 fish oils, Niacin, and/or L-Carnitine. If taking those supplements, exercise and the diet above do not bring your lipids withing range, talk to your doctor about getting a prescrition of a lipid lowering drug or combination of drugs.

7- Minimize your sugar, soft drinks, junk food, and animal fat.

8- Maximize your protein from lean sources (chicken, white turkey meat, eggs, fat free cheese, fish, lean beef, nuts)

9- If you are one of the lucky ones that can get Serostim paid by insurance, talk to your doctor about getting a prescription. Serostim (growth hormone) has been shown to be effective to reduce belly fat at 3-4 mg/day, but it is not approved for lipodystrophy but for wasting syndrome.

10- If you are losing muscle mass, ask yoru doctor for Oxandrin or Deca Durabolin. More details in my book "Built to Survive",

11- Ask your doctor to run a glucose tolerance test to see how your body handles glucose. If it is gluxose tolerance is impaired, talk to him about Metformin (Glucophage). Glucophage, unlike Avandia and Actos, has been shown to reduce belly fat, specially in combination with exercise.

I hope this helps some!

Nelson Vergel

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