Breaking the barriers to good eating
Almost every day we hear or read about a new nutrition breakthrough that will make life with HIV easier to live with. The supply of medicinal herbs is seemingly endless -- and getting longer. And there's always a new supplement that we can no longer live without. The single group of nutrients that has gotten the most attention recently is the phytochemicals found in edible plants. These nutrients are by far the most promising for improving our health.
Whenever we come across new nutrition information, we have two problems. The first is making sure that information is complete and accurate. The second is that reading or knowing the facts is not enough; we have to eat the foods where the nutrients are found.
Let's assume you have a good nutritionist who learns the new information and can steer you away from products whose only virtue is to enrich their manufacturer and toward the foods that will do you the most good. You're still left with the second problem -- learning to eat the foods that get the nutrients from our brains to our stomachs. Nutritionists are not surgeons; they can't cut us open, remove the old or bad nutrition, and replace it with a new or good one. To get the benefits of the new nutritional information, we have to eat it!
And that's the hard part. How many times have we said to ourselves that we should cut out the junk food, eat more fruits and vegetables, use skim milk instead of whole milk, cut down on soda? But the food seems to have a mind of its own. It is almost as if junk food has a voice that calls to us in the night when we are tired and weak and cannot resist. The only way to shut it up is to eat that whole box of chocolate doughnuts!
There is hope. Don't fret. Read on for some suggestions to help you resist the lure of the junk-food siren.
Where you are is where you have to start. You need to ask yourself if you are being realistic about your goals. If you don't really believe that a change in your diet will do you any good, or if you believe that a particular diet is a secret cure, your chances of succeeding are small. If you are used to eating two eight-ounce hamburgers for dinner every night and your vegetables are french fries, ketchup, and relish, don't go home and throw out all your food because you've decided to become a vegetarian. You will fail.
Your failure won't be a peaceful one, either. It will most likely be filled with guilt and frustration at yourself and anger at the nutritionist or anyone else who encouraged you to try to change.
So, the first thing to do is to take stock of yourself and your refrigerator. Ask yourself, "What kind of eater am I? Am I a SAD eater? (That stands for "Standard American Diet" -- one with too much fat, too much protein, too much salt, and not enough whole grains and fruits and vegetables.) Is the first meal of my day a cigarette? Is it a cigarette, a cup of coffee with half and half and nine sugars, and a packaged Danish? Do I have to get up, take my meds, and wait for two hours before I eat? Or do I get up, get ready as fast as I can, and run out of the house, hoping to grab something along the way to eat in the luxurious surroundings of the subway?"
On the other hand, maybe you are eating fruits, vegetables, good-quality carbohydrates, and the right amounts of fats and protein, and you just need help fine-tuning an already good diet. Maybe you just need a break from being responsible for providing meals for yourself and your kids three times a day, seven days a week. With everything else you have to do, including eating and taking your meds on schedule, filling up the family on junk food that is fast and effortless may look like a good alternative to shopping, cooking, and cleaning up.
The next thing to ask yourself is, "Do I cook? Is cooking a pleasure or a chore? Do I have a kitchen to cook in, or am I in an SRO where boiling water is a felony?" If you live in a place where you can't cook or store food, for whatever reason, the most important step to good nutrition may be to move. Without a place to cook, it is even harder to change your eating habits. When you have to eat out every day, it is very hard, if not impossible, to control what is in your food.
"Do I cook only for myself, or do I have family or friends who count on my meal preparation? Are they going to like the changes I want to make?" This is a big problem, especially if there are children in your household or other people with special dietary needs. If you find preparing one nutritious meal daunting, it could really be impossible to prepare two different menus for each meal.
The third question is financial: "Can I afford to change? Am I stretching my small budget just to maintain my current diet? Do I have lots of condiments and other expensive items that I bought a little at a time? Will I have to buy lots of new and expensive items in order to eat better?"
The last and perhaps the most important question of all is, "Am I going to like the changes that I should make in order to do better?" Having HIV has forced you to make many unpleasant lifestyle changes, including what and when to eat, that you may have no more room for any more shoulds. Are you thinking, "Having sex wrapped in a full-size plastic bag was the last straw! If I have to eat the same way, forget it!"
Get A Chef
If I tried to convince you that changing your diet for the better would be effortless, I would be lying. It is going to take some effort.
One of the first things to realize is that change is easiest to make and most likely to last if you do it in small doses, and if it is pleasurable. So the first thing I suggest you do is have someone else do your cooking for you, at least some of the time. Get your own chef! That chef should be an HIV cooking specialist, and the "restaurant" where the chef works should be a place that understands your needs and welcomes you and your family, no matter how you define it. It should be a place where you can get nutrition counseling on demand, where other people are dealing with similar problems, where you can experience dietary change that is fun, delicious, educational, and low-cost or free.
I am not hallucinating. Such places do exist in the United States. They are called congregate meals programs. If you live in a big city, there is probably such a program nearby (see "Be Our Guest!" Body Positive, May 1999). Very often you can go to these meals programs every day or several times each week or month. So, instead of dietary change being a drain on your finances, you will find that your bankroll grow as a result of going to a congregate meals program regularly.
Eating at congregate meals programs will also allow you to experiment with foods you are not used to with very little aggravation. For example, it can be emotionally stressful to try to cook something new if failure means missing a meal or having a hungry, cranky child to deal with. Trying a new vegetable becomes a simple matter if all you have to do if you don't like it is to throw it away and try something else. Another advantage is that if you eat something new that is good for you and you do like it, you can get the recipe from the chef who prepared the dish, along with some pointers on how to prepare it at home yourself.
Another benefit of a congregate meals program is that it's also a place to learn how to cut down on salt, or fat, without cutting down on taste. One of the major complaints of people who have to cut down on salt is that their food tastes bland or flat. It is not enough to be told that you have high blood pressure and that if you don't want to have a stroke, you had better cut down on your salt and get used to the flat taste. You have to do this for the rest of your life! How dreary! It's much better to learn about the dozens of spices that can be used with different foods and that are so flavorful you won't even know that the salt isn't there. There is no better way to learn about how good they taste than by eating a dish that is delicious and learning afterward that it has little or no salt but is made with lots of spices.
Spices are the dried parts of specific plants that have very strong concentrated flavors. They include roots, bark, leaves, seeds, flowers, and buds. Here is a very short list of cheap and easily found spices: allspice, anise, caraway, cardamom, cayenne, celery seed, chives, cinnamon, cloves, coriander, cumin, dill, fagara (Szechuan pepper), fennel, fenugreek, garlic, ginger, gumbo file, juniper berries, mace, marjoram, mint, mustard seed, nutmeg, onion, oregano, paprika, parsley, pepper (black, white, green, pink, red, or cayenne), poppy seeds, rosemary, saffron, sage, savory, sesame seeds, tarragon, thyme, and turmeric.
You probably noticed that many of the spices on the list are also medicinal herbs. More for your money!
The foods you can use these spices in range from soup to nuts. Of course the trick is to learn where to use them. Why not go to your local public library, take out a cookbook with a good section on herbs and spices, and copy the charts and hang them in your kitchen for easy reference. The next time you cook something that you think needs lots of salt, reach for your spice bottles instead.
Become A Chef
Another advantage of a congregate meals program is that many of them offer cooking classes. If yours doesn't, look for a class somewhere else.
An important point to remember about being well-nourished is that eating enough food is only step one. Step two is absorbing what you have eaten. If HIV, aging, or your medication is making your stomach work less efficiently than it should, cooking to make food more digestible is a good idea. Learning to cook has obvious advantages, like getting food to taste better and being able to prepare something that helps you fight the virus. But this skill also has a hidden advantage: You can increase the absorption of certain nutrients from food by cooking it properly. For example, a phytonutrient called lycopene, a member of the important carotene family, is absorbed best when it is cooked with oil. You can absorb the maximum amount of protein from meat, poultry, or fish if you cook it with moist heat like steaming or boiling, in soups or stews, rather than with dry heat like roasting or frying.
Getting the right amount of protein is very important in HIV. Ask your nutritionist to help you work out your protein needs based on your health, age, gender, size, and activity level. Having bioelectrical impedance analysis (see "Weighing In -- The Modern Way," Body Positive, August 1999) will also help you figure it out.
Aside from the main focus of a cooking class, which is learning how to cook, getting together with other people who have similar goals, interests, and problems makes the struggle to change a lot more bearable. Isolation and loneliness are big problems for people who are HIV-positive, especially those who are over 50, and a class may become more than just a lesson in how to cook. It can help solve another important problem -- depression As we know, depression can lead to dangerous behaviors, such as overeating and not eating.
Watch The Salt . . .
In addition to teaching what to do at the stove, cooking classes often take trips to the supermarket for lessons in shopping. One of the most important things you can learn how to do on those shopping trips is to read labels. Using salt as an example again, you will be amazed to read how much salt is in prepared foods. And the word "salt" is often replaced by its scientific name, "sodium." "MSG" stands for monosodium glutamate. It is often called a flavor enhancer. I call it salt. We also see sodium phosphate, disodium inosinate, and disodium guanylate. Salt, salt, and salt. If the label says "sodium" anywhere in its list of ingredients, that's salt.
Prepared foods are also more expensive to buy than their uncooked cousins. So try buying one or two fresh items and flavor them yourself, using your newfound knowledge about spices. As you start eating fewer and fewer salty foods, you will notice that your taste will begin to change. Food that at one time tasted just right will begin to taste too salty.
A good experiment is to take a bite of a food like rice before you put any salt on it. Then put less salt on it than you usually do and take another bite. You will probably find that the rice will taste as salty as you like it.
. . . And The Sugar . . .
If you are under 50, by the time you were 7 years old you had already watched 140,000 television commercials, many of them about food. One of the main foods those TV commercials were trying to convince you to eat was sugar -- sugar in countless forms and with many different names. Sugar is found in soft drinks, which are really just liquid lollipops; in sugar-frosted breakfast cereal, more accurately described as candy in a box that opens from the top; in so-called fruit drinks such as cranberry-apple cocktail, which are often only ten percent fruit juice and ninety percent colored sugar water; in muffins, which could also be known as round cake, often loaded with trans fats (more on trans fats later); and in jams and jellies that are no more than colored sugar-water. Calling this stuff junk food is an understatement.
Aside from the well-known tooth-rotting properties of sugar, it poses four other problems for people with compromised immune systems. The first is that it depresses the immune system for several hours after you eat it. The second is that the vitamins you need to process these empty calories into energy are not there, so your body has to supply them. Third, these dead foods displace real foods from your diet. If your appetite is less than it should be to begin with, you really are doing yourself some harm. Finally, the "package" that these sugars come in, for example that breakfast Danish, is frequently loaded with unnatural trans fat that your body does not know how to deal with. Eating trans fats is linked to getting cancer.
If you're used to eating a lot of sweets, it can be very difficult to cut back. Don't try to do it all at once. For starters, don't keep sweets in the house. You will probably eat less outside Try eating raisins and other dried fruit at home. Another way you can cut down on your sugar is similar to what you did with salt. Fool your tongue again. Let's say you are that person who likes nine sugars and cream in the morning coffee. While the coffee is black, before you put anything in it, take a sip and swish it around your mouth before you swallow it. Very bitter, right? I guarantee that any sugar you put in that coffee afterwards will taste much sweeter than before and you can use less.
. . . And The Fats
Eating too much and the wrong kinds of fat is a problem that is connected to eating too much salt, sugar, protein, and poor-quality carbohydrates. Remember, we are trying to eat the right amount of high-quality food. We all like fat. If we didn't, it wouldn't be a dietary problem.
There are some fats we should avoid completely, like margarine, other hydrogenated oils, and the synthetic no-fat fats like olestra. There are fats to cut down on, like saturated fat and the cholesterol found in animal products. Some we should eat more frequently, such as the omega 3-containing fat found in fish that live in cold salt water, and the monounsaturated fat found in olive and peanut oil.
To help cut down, the first thing to do is to stop spending your food money at the hot dog vendors on the street and at the fast-food hamburger restaurants. Cook at home or go to a congregate meals program. If you have to eat on the run, pack some nonperishable food to take with you the night before you leave. Take a piece of fruit, a tomato, a whole-wheat bagel, a pop-top can of tuna (water-packed), and a bottle of orange juice for example. If that isn't practical, try stopping at a deli and ordering a sandwich that you compose -- for example, sardines or tuna packed in spring water, or grilled white-meat chicken on some whole-wheat bread. Add lettuce and tomatoes one day, cole slaw the next, a small container of cooked vegetables the third. Go into a Chinese restaurant that has a low-fat menu section and see if that works. Ask if the kitchen can mix some brown and white rice together. You won't even know the brown rice is there.
Try using low-fat or nonfat dairy products at home and cooking with olive or peanut oil. The possibilities are endless once you decide to make the change. Don't decide in advance that you won't like something. Try it a few times. One of the most interesting developments in the opening of specialty shops that sell only fat-free and sugar-free products. It's too early to tell if these will become a healthy and affordable addition to the food-buying landscape or if they are just the newest trendy spot for affluent food faddists to drop some coin. But if there's one near you, it's worth checking out.
Eat more vegetables! The more we learn about vegetables and other plant foods, the better they look for our health. We know they can prevent certain cancers, prevent and reverse certain heart disease, prevent or reverse hypertension, and help us control diarrhea and constipation.
Vegetables contain a host of the antioxidants necessary to fight HIV disease. A new measurement for these naturally occurring antioxidants is oxygen radical absorbance capacity, or ORAC. These nutrients are probably better absorbed from plants than from pills. An added bonus is that when we eat our fruits and vegetables, we also get the nutrients that haven't been discovered yet! Ask your nutritionist for a copy of the food pyramid and hang it on your refrigerator door. If you find that you are full before you get around to eating your vegetables, eat the veggies first.
One Step (Or Food) At A Time
A word of caution: You have been eating a certain way your whole life. Don't try to change overnight. In spite of all the drawbacks of SAD, I don't advise anyone who eats a lot of junk food to try to stop cold turkey.
You can bet the foods all those television commercials were trying to convince you to eat were not brown rice and beans with collard greens! Make changes slowly and one at a time so you don't overwhelm yourself. Cold-turkey treatments work for only that a small group of people. Most of us do better with slow and easy methods.
Change is not easy, but it is the only thing that is constant in life. So let's try to change our eating habits for the better. It can be done with some help from the right people and some hard work from you. The reward is better health, and that is certainly worthwhile.
And EAT YOUR VEGETABLES!
Edwin Krales is Coordinator of Nutrition and Outreach at the Momentum AIDS Project.
This article was provided by Body Positive. It is a part of the publication Body Positive.