HIV and the Recession: Living Well in Tough Times
"That is, without a doubt, one of the most important aspects of maintaining good health, period," said Johnson. "Eating well [and] sleeping enough hours are linked to a healthy immune system."
But how many of us do that -- HIV positive or not? Johnson admits he's often up late and then awake "as soon as the sun peeks up over the horizon."
For many people, the key to incorporating good basic nutrition into their lives is to make small changes that become a permanent part of their routine, according to Cade Fields-Gardner, director of services for the Cutting Edge, a Chicago-based organization dedicated to improving nutrition for HIV positive people.
"The good news is that the body is a pretty amazing thing. If you take care of it at all, it will take care of you," said Fields-Gardner, who has specialized in HIV care for 22 years. "But, as with adjusting to a pill regimen, it may take a while to adapt to lifestyle changes."
You can do it, and it doesn't have to be painful if you take things a step at a time.
Let's start with that elusive eight hours of sleep. For everyone, those hours may be interrupted by worry, depression, work, or children. HIV positive people have an added challenge: Some HIV medications can cause insomnia or poor sleep, including the widely used efavirenz (Sustiva, also in the Truvada and Atripla combination pills).
Don't be afraid to speak up about insomnia and ask your clinician about other antiretroviral options that will let you get much-needed rest.
"Many times, you'll get started on a medication and the side effects will be strong," said Fenway's Boswell. "But they usually gradually resolve over a period of weeks. If that doesn't happen, especially if there are more options, your clinician [can] move you off that medication, because of the need for sleep."
It also helps to create a routine. Reyes said staffers at HELP/PSI often work closely with clients to help them develop new bedtime routines that do not include working or playing on computers, watching TV, or other late-night activities. It may be painful at first to give up your evening entertainment, but making small changes -- such as not watching programs that rile you up just before bed, or turning the lights low before sleep -- will eventually take hold and help create healthier sleep habits, she said.
Eat Real Food
"I gave up french fries and started eating more salads," he said. "Instead of eating donuts, I am eating fat-free licorice."
It's not perfect, of course, but Mike's approach is still a good one, said Fields-Gardner. And there's a good reason to get started today. For HIV positive people, just having the virus changes the body's metabolism.
"HIV is a chronic inflammatory disease, which it has in common with rheumatoid arthritis, Crohn's disease, and others," explained Fields-Gardner. "What chronic inflammation does is change the way muscle and fat are metabolized in your system. These changes affect muscle, bone, and other tissue."
Chronic HIV infection also changes how sensitive your body is to natural hormones, which can lead to increased resistance to testosterone, growth hormone, and, notably, insulin.
Insulin allows glucose from food to enter cells, where it is used as a source of energy. When insulin resistance develops, cells do not respond properly to insulin, allowing glucose to build up in the blood. In other words, the body has to work harder to come down from a "sugar high." Over time, insulin resistance can progress to prediabetes or even diabetes. (For more information, see "HIV/AIDS and Diabetes: Minimizing Risk, Optimizing Care" in the Winter/Spring 2009 issue of BETA.)
Another issue for people with HIV is altered fat metabolism. Chronic HIV infection, antiretroviral drugs, or a combination of the two can lead to abnormal levels of cholesterol and triglycerides in the blood, which in turn increase the risk of cardiovascular disease. While it's good advice for everyone, it is especially important for people with HIV to avoid a high-fat diet and maintain a healthy weight.
Build a New Rut
If you're a fast-food junkie or love an occasional sugary snack, no need to fear: Eating well with HIV does not have to mean resigning yourself to a life of brown rice and raw foods.
Like Mike, you can take small steps toward better-for-you treats. If you love sugary soda and eat fast food every day, maybe start by choosing beverages with less sugar and switching to some of the healthier items on the menu, suggested Fields-Gardner. If you crave steak, reduce the portion size while adding a side dish of healthier (and more budget-friendly) foods such as beans or lentils. This can help you get accustomed to new flavors while you learn to prepare and enjoy unfamiliar foods.
"I like the idea that people don't live nutrition," said Fields-Gardner. "You figure it out, you build a good rut with healthy foods, and then you move on with your life."
To build that new rut, you have to stick with small changes over a period of time. It can take three days for your body to establish a new pattern, but months for your brain to adjust to those changes and for them to become ingrained, she said. During that time, don't sabotage yourself by attempting unsustainable major changes to your diet.
Try Home Cooking
But there is a happy medium. Some organizations, like HELP/PSI, offer cooking classes for HIV positive people, so they can learn inexpensive ways to prepare nutritious meals at home.
One of the best options, said Shane Convery, Program Director for San Francisco's Immune Enhancement Project (IEP), is stews. His program teaches people how to cook a flavorful and healthful stew, even if all they have to work with is a hot plate in a single-room-occupancy hotel. Stews, he added, end up being nutritious and cheap because they're mostly made from beans and inexpensive cuts of meat.
If even this seems like too much effort, there are plenty of healthy options that don't require any cooking at all, for example homemade sandwiches of lean meat and vegetables, or whole grain cereal with low-fat milk.
In addition, preparing food at home puts you in control of what ingredients go into your meals, rather than leaving those choices up to restaurant chefs and fast-food cooks. "The side effect of eating at home is that, yes, it's less expensive, but you make better food choices, as well," Convery said.
Go Farm Fresh
Farmer's markets can be a cornucopia of healthy foods. But it turns out they can also be cost effective, said Convery. In a survey conducted recently by IEP, produce cost slightly less at farmer's markets than at supermarkets. And because they weren't shipped across the country and stored in warehouses for weeks or even months, the fruits and vegetables offered at farmer's markets are fresher and tastier.
Many farmers are willing to negotiate prices, especially if you visit their stalls late in the day as they're packing up. That way, they don't have to haul unsold produce home and you don't have to pay full price.
And you can use food stamps at many farmer's markets. Food stamps and food pantries were created for people who need healthy food and cannot afford to buy it on their own. People who are permanently disabled are automatically eligible for the U.S. Department of Agriculture's (USDA) food stamp program, but must not earn more than 165% of the federal poverty level. Visit the USDA's searchable farmer's market database (listed in the table above) to locate markets that accept food stamps and other vouchers for nutritional assistance.
Despite Michael's challenges, he's kept up one thing: his yoga practice.
"I like a particular type of yoga called hatha yoga," he said. "It's very meditative, slow, quiet." Although Michael also enjoys other, more rigorous forms of exercise, he finds that yoga offers extra benefits. "It's not only good for you physically; it's great mentally, as well. It can be a way to calm your mind. There are so many benefits other than physical."
For years, yoga has been shown to counter chronic stress, depression, and anxiety. Emerging research is beginning to suggest that the flood of the hormone norepinephrine (also known as noradrenaline) that comes with intense stress allows HIV to replicate more rapidly in the body. And studies suggest that yoga may help staunch the flow of norepinephrine throughout the body.
Other studies have found that yoga may be helpful in coping with medication side effects such as peripheral neuropathy. This makes yoga particularly beneficial, as research shows that persistent side effects from medications are a good predictor of poor treatment adherence.
But how can you find yoga, acupuncture, and other complementary therapies that you can afford? After all, at $15 per yoga class and more than $100 per acupuncture session, the cost can be prohibitive.
Ask Your One-Stop Shop
Many one-stop HIV/AIDS centers such as HELP/PSI and Gay Men's Health Crisis offer complementary therapies to their clients. If they don't, they may be able to direct you to local agencies or groups that do offer those therapies for low rates or free.
For instance, the Desert AIDS Project in Palm Springs, California, provides yoga classes tailored to the symptoms and immune health of its HIV positive clients. In San Francisco, the Integral Yoga Institute offers affordable classes for people with HIV/AIDS, and offers work exchange. Call your local organization and ask if they offer something similar.
Work it Out
Acupuncture is usually expensive, but not at IEP's drop-in clinic. Three days per week, the organization offers acupuncture for a donation -- anywhere from $5 to $20. "But no one will be turned away if they can't afford it," said Convery. "We'll gladly accept $4, $3, $2."
"Some of us are willing to create work exchange plans with people who'd like acupuncture but can't afford to pay for it," Convery said. "We're certainly thrilled to have the volunteers -- and I think every organization right now is thrilled to have that. What you do when you volunteer can be tailored to your energy levels, and it's a great way to get new skills, be active, and get out."
As with newly trained mental health service providers, many senior-level acupuncture students and massage therapists are looking for practice. In San Francisco, the American College of Traditional Chinese Medicine has student clinics that offer the same services others charge full-price for, but at discounted rates. Students are supervised by experienced practitioners to ensure high-quality care.
This article was provided by San Francisco AIDS Foundation. It is a part of the publication Bulletin of Experimental Treatments for AIDS. Visit San Francisco AIDS Foundation's Web site to find out more about their activities, publications and services.
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