Speakers: Jan Zimmerman, nutritionist, Village Center for Care, AIDS Day Treatment Program
Sean Crawford, clinical exercise specialist, GMHC volunteer
We all know that we should eat right and exercise, but turning knowledge into action requires energy, time, and support. The benefits of good nutrition and exercise are well worth the effort, however, especially for people living with HIV. At the July community forum, Jan Zimmerman, a nutritionist at the Village Center for Care AIDS Day Treatment Program, and Sean Crawford, a clinical exercise specialist, shared valuable information about the ways in which diet, supplements, and exercise contribute to overall health and HIV treatment.
Nutrition and HIV
In her presentation entitled "Building Health and Healing with HIV/AIDS," Jan Zimmerman provided practical advice about food and supplement choices. These choices are just one part of healthy living, however. Ms. Zimmerman views emotional and spiritual health
as the foundation for health and healing. You can use support groups, conversations with friends, meditation, or church, among other resources, to support your emotional and spiritual health, but your emotional health must be well established before you undertake healing nutrition and exercise
. The final component of health and healing, especially in HIV disease, is medication and side effect management
. These three elements of health and healing must be practiced daily.
HIV nutrition specialists can help you do more than just gain or lose weight. They can provide guidance on both HIV-related and medication-related ailments, including appetite loss, bloating/gas, diarrhea, kidney disease, lipodystrophy, and wasting. Some of these conditions can be treated without pharmaceutical interventions.
Ms. Zimmerman explained the general principles of Nutritional Healing in HIV/AIDS upon which she bases her practice:
- Maintain normal body weight.
- Be aware of the caloric intake you need to achieve and maintain a normal weight.
- Build muscles/maintain lean body mass (avoid wasting).
- Use strength training and, if necessary, steroids or hormones to build/maintain muscle mass.
- Optimize digestion.
- The digestive tract is your center of health -- simple steps like chewing your food carefully can make its job much easier!
- Eating 4-6 small meals is more efficient than eating 1-3 large meals.
- Eat more "healing foods," fewer processed foods.
- Drink 6-10 cups of non-caffeinated fluids daily.
- Use supplements rationally and consistently.
- Address social and emotional isolation, as these factors can negatively influence your food choices.
Foods that Heal
Following a "healing foods" diet involves choosing foods that have a positive influence on your health. The benefits of a healing foods diet include increased energy level and a healthier heart. A healing foods diet is not about deprivation, but instead focuses on harm reduction and moderation.
To get started, follow these guidelines:
Protein (at least 3-6 servings per day)
- Lean meats, fish, poultry (no skin), lowfat dairy products, beans, nuts, seeds, soy products
Tip: Try walnut butter -- grind walnuts in a blender with a touch of olive oil for a high-protein treat.
Carbs (at least 5 servings per day)
- Whole grains (oatmeal, high-fiber cereal, barley, whole wheat bread)
Tip: High-fiber cereal should have at least 5 grams of fiber per serving -- check the box!
Fruits and Vegetables (5 servings per day)
- All fresh, frozen, and dried fruits and vegetables
Tip: Make shakes to get your day's fruit into one glass.
Fats (1-2 servings per day)
- "Cold-pressed" olive, canola, and sunflower oil, "trans-free" margarine, cold water fish (salmon, sardines, mackerel), avocados
Tip: Promise brand "trans-free" margarine is Jan's pick for a butter substitute.
Calcium-Rich Foods (3 servings per day or a supplement)
- Lowfat dairy products, calcium-enriched juice
Tip: Chomp on Tums for calcium if you have a hard time getting enough in your diet.
High-Fat Protein (max 2-3 servings per week)
- Fatty meats (hamburger, hot dogs, bacon, sausage), fried chicken, high-fat dairy products (whole milk, cheese, ice cream)
High-Fat Carbs (max 2-3 servings per week)
- Refined sugars (cakes, cookies, candy, soda, and sugary cereal), white flour (doughnuts and pastry), French fries
Fats (as little as possible)
- Butter, cream, lard, Crisco
Try to drink less coffee, tea, cola, and avoid excessive beer, wine, or liquor consumption. All of these beverages contribute to dehydration.
The Story on Supplements
Supplements can be beneficial as just that: supplements to a well balanced healing foods diet. Supplements are not a substitute for the vitamins in food. If you'd like to start taking supplements, consult with an HIV nutrition specialist to help you develop a supplement regimen that meets your needs. In general:
- Use supplements consistently for 6-8 weeks in order to see results.
- Never take supplements on an empty stomach: they will be absorbed more effectively if you take them with food.
- Tell your primary care provider about the supplements that you are taking.
Some specific supplement suggestions are:
(Boost, Ensure, etc.)
Use: weight gain
*not for people with severe thrush or yeast infections
- Protein Powders
(whey, glutamine, soy)
Use: increase protein intake (can help build/preserve muscle mass)
*not for people with severe liver or kidney disease
- Therapeutic Multivitamins
Use: provides 100% of the recommended daily allowance of many vitamins
This is the only supplement directly related to improved mortality in HIV infection. The recommended daily allowance can be obtained in 1-2 Brazil nuts or in pill form.
- Alpha Lipoic/Thioctic Acid
Good for liver detoxification and neuropathy relief.
Use: preserves bone, muscle, and nerve function
May help treat diarrhea.
- Coenzyme Q10
Use: support body's energy pathways
May aid in mitochondrial toxicity from long-term antiretroviral use.
For further information on nutrition's role in HIV care, Ms. Zimmerman recommends reading Healing HIV: How to Rebuild Your Immune System by Jon Kaiser and Nutrition and HIV: A New Model for Treatment by Mary Romeyn.
The Fitness Contribution
The other component of healthy living is physical fitness. In his presentation, Sean Crawford described the three components of fitness: flexibility, strength, and cardiovascular conditioning. Increased flexibility can be attained through stretching, yoga, or tai chi, or even just touching your toes every morning! Weight lifting, body weight exercises (such as pull-ups and sit-ups), and calisthenics (such as squats, crunches, and lunges) are activities commonly used to develop strength. Cardiovascular conditioning is participating in activities that push you above and beyond your activity of daily living. These activities may include walking, running, biking, swimming -- anything that gets your heart rate up and that you enjoy. All three components of fitness are important. But for people with HIV, especially those who are wasting, strength training to build and maintain muscle is the most valuable activity.
Strength training can also:
- Improve immune function
- Increase appetite
- Increase metabolism
- Increase bone density
- Increase functionality (allow you to perform physical tasks with greater ease)
Have you been thinking about starting an exercise program? According to Mr. Crawford, you're in the contemplation stage of developing a lifelong exercise regimen. Good for you! This is the first step. There are plenty of people who haven't made it that far, and may never incorporate exercise into their lives. Your next task is preparation -- gathering the equipment you will need to participate in an exercise regimen. This could include a good pair of running shoes, a gym membership, a new soccer ball or tennis racket, some handweights, or a pair of Rollerblades. Whatever you choose, remember that it will be easier to stick with an exercise regimen if you actually enjoy what you're doing.
Now, take action! You should start with 20 to 30 minutes of aerobic activity three to four times a week. You can increase this amount as you get stronger, but you should always factor in some time for your muscles to rest.
Maintaining a regimen year-round can be even more challenging that beginning to exercise in the first place. Try to stick with it! If you relapse into a period without exercise, start again as soon as you can. It will help to set both long- and short-term fitness goals for yourself and to reward yourself when you reach those goals.
If you're beginning a strength-training regimen that includes weights and/or equipment, supervised instruction is a must, particularly at first. This can mean taking classes or a trainer to help you work out a safe and helpful regimen.
A Final Note
As you start to incorporate nutrition and fitness into your life, remember that small changes, such as switching from whole milk to skim milk or walking 10 blocks instead of taking the bus, can make a difference. If these small changes become lifelong good habits, you will enjoy better overall health while living with HIV.