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Dietary Supplements and Diabetes

Previous issues of the HIV ReSource Review have discussed the use of dietary supplements for glucose control in diabetes. (1, 2) Several papers of note have been published since that time and are noted in the Nov/Dec 2003 HIV Nutrition Update. Of the 15 randomized clinical trials of chromium on glucose and insulin responses in people with glucose intolerance or Type 2 diabetes reporting adequate data, only one showed that chromium reduced glucose and insulin concentrations and significantly reduced glycosylated hemoglobin (HbA1c). (3)

Nutrition 21 recently funded an unrestricted research grant of Chromax® chromium picolinate, which they market. (4) Results of 16 type 2 diabetics enrolled in a double-blind randomized placebo controlled trial suggest that when chromium picolinate is added to the diet, insulin sensitivity improves. 

Chromium is an essential mineral that is a co-factor of insulin and James Komorowski, MS, Vice President of Technical Services and Scientific Affairs, Nutrition 21, Inc., notes it may be a cost effective nutrition therapy for people with diabetes. Additional information on chromium and glucose abnormalities are at the Nutrition 21 web site.

Rodent studies completed in Canada suggest that buckwheat seed may lower blood glucose levels. (5) The chemically synthesized compound d-chiro-inositol plays a role in glucose metabolism and cell signaling and is the key component in buckwheat seed. Recent research of 60 people with type 2 diabetes randomly divided into six groups during a short-term study revealed that cinnamon can also improve both glucose and lipid levels. (6) Researchers reported reductions in mean fasting serum glucose, triglyceride, LDL cholesterol, and total cholesterol levels. 

Sources
1. Herr S. Potential Herb-Drug Interactions For HIV-positive Patients. HIV ReSource Review 2001;5(4):1-9, 22.
2. Herr S. Potential Herb-Drug Interactions For HIV-positive Patients: Part Two. HIV ReSource Review 2001;5(5):1-9, 22.
3. Althuis MD, Jordan NE, Ludington EA, et al. Glucose And Insulin Responses To Dietary Chromium Supplements: A Meta-Analysis. Am J Clin Nutr 2002;76(1):148-55. 
4. New Clinical Study Uncovers Mechanism By Which Chromium Picolinate May Enhance Insulin Sensitivity. Effective and safe complementary nutrition therapy. PARIS, France, August 28, 2003. Nutrition 21, Inc. web site. 
5. Kawa JM, Taylor CG, Przybylski R. Buckwheat Concentrate Reduces Serum Glucose in Streptozotocin-Diabetic Rats. J Agric Food Chem 2003;51(25):7287-7291.
6. Khan A, Safdar M, Ali Khan MM, Khattak KN, Anderson RA. Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes. Diabetes Care 2003;26:3215-3218.

Subscriber Response Appreciated

Your support of HIV ReSources allows us to continue this free service along with our popular HIV ReSources web site. If you find the weekly HIV Nutrition News Update useful, consider visiting our Recommended Books & Videos links and making purchases at Amazon.com through them. It is only through purchases from organizations and individuals like you, who recognize the value of our services, that we are able to offer them. All of our staff are volunteers and every penny you spend helps to cover the costs associated with the services we provide.
 

More on Glucose Abnormalities 

Recent publications add to the glucose abnormalities information presented in our previously published resources: HIV ReSource Review newsletters (Issue 27 and Issue 28); HIV Nutrition Update (Issue45 ); and weekly updates (Mailing List Archive Two-1 and Mailing List Archive Two-2). 

Approximately 17 million Americans have diabetes and another 16 million Americans have pre-diabetes, a condition in which blood glucose levels are higher than normal. (1) One in three people who have diabetes don't know they have it and two out of three people with the disease die from heart disease or stroke. Diabetic symptoms include: frequent urination, excessive thirst, extreme hunger, unusual weight loss, increased fatigue, irritability, and blurry vision. Rodent studies suggest that tumor necrosis factor (TNF)-alpha may cause insulin resistance and dyslipidemia and blocking the action of TNF-alpha in fat tissue may prevent TNF-alpha-induced insulin resistance in vivo. (2) Researchers recently noted that just eating breakfast may help to reduce the risk of obesity, diabetes, and heart disease. 

Stanford University School of Medicine researchers report that measuring triglyceride levels, or the triglyceride-HDL (high- density lipoprotein) cholesterol ratio is a relatively simple and practical method to identify overweight individuals who are insulin resistant. (3) Preliminary studies showed that elevated homocysteine levels in people with Type 2 diabetes may be a marker for cognitive decline. (4) 

Hurst and Lee note that Type 2 diabetes should be considered a vascular disease because it places diabetic patients at greater risk of having atherosclerosis. (5) They reveal that effective pharmacologic and lifestyle interventions are underutilized and diabetics benefit more from treatments that reduce coronary artery disease risk. Newly published articles in the Journal of the American Dietetic Association and the American Diabetes Association compliment the information we have published over the past five years. Dietary treatment of Insulin Resistance Syndrome (Syndrome X) is now more frequently including fiber-rich carbohydrates. (6) In a recent study, intake of
viscous fiber and pectin decreased progression of atherosclerosis and was inversely related to the ratio of total to HDL cholesterol. (7) 

For further information refer to the publications listed above and: 
* Screening Adults for Type 2 Diabetes Mellitus: Recommendations from the U.S.- Preventive Services Task Force
* Diabetes. Link Between Diabetes and Cardiovascular Disease
* MEDLINEplus topic- Diabetes
* Evidence-Based Nutrition Principles And Recommendations For The Treatment And Prevention Of Diabetes And Related Complications

Sources 
1. Meadows M. How to Keep Your Heart Healthy. FDA Consumer magazine, Nov/Dec 2003. 
2. Ruan H, Miles PDG, Ladd CM, et al. Profiling Gene Transcription In Vivo Reveals Adipose Tissue as an Immediate Target of Tumor Necrosis Factor-alpha: Implications
for Insulin Resistance. Diabetes 2002;51:3176-3188. 
3. McLaughlin T, Abbasi F, Cheal K, Chu J, et al. Use of Metabolic Markers To Identify Overweight Individuals Who Are Insulin Resistant. Ann Intern Med 2003;139(10):802-809. 
4. de Luis DA, Fernandez N, Arranz M, Aller R, Izaola O. Total homocysteine and cognitive deterioration in people with type 2 diabetes. Diabetes Res Clin Pract. 2002;55(3):185-90. 
5. Hurst RT, Lee RW. Increased Incidence of Coronary Atherosclerosis in Type 2 Diabetes Mellitus: Mechanisms and Management. Ann Intern Med 2003;139(10):824-834. 
6. Davy BM, Melby CL. The Effect Of Fiber-Rich Carbohydrates On Features Of Syndrome X. J Am Diet Assoc 2003;103:86-96. 
7. Wu H, Dwyer KM, Fan Z, et al. Dietary Fiber And Progression Of Atherosclerosis: The Los Angeles Atherosclerosis Study. Am J Clin Nutr 2003;78(6):1085-1091.
 

HIV ReSources Web Site Update

12/11/03 - The HIV ReSources Web Site is updated. 

New pages: 
Issue 45 HIV Nutrition Update

Electronic Newsletter Archive - Issue Two-B

New links: 
Recommended Books On Nutrition, and Nutrition And HIV

Conferences, Updates, Online Classes, And Webcasts

Recommended Books For People Living With HIV 

Recommended Books On Medications, Nutrients & Herbs

Recommended Books For People Living With Hepatitis & HIV

Easy Reading Books, CDs and Videos

FSIS News Release

USDA Suggests, "Give the Gift of Food Safety" 

Contact: Steven Cohen (202) 720-9113 or Susan Conley (301) 504-9605 
WASHINGTON, Dec. 9, 2003- This year, the U.S. Department of Agriculture (USDA) suggests placing food safety gifts on your holiday shopping list. Keeping your loved ones safe may be the best gift of all. There are a number of helpful kitchen devices available in stores and catalogs that will interest every person and one size will fit all levels of cooking skills. 

A food thermometer is perfect for a stocking stuffer.  Monitoring the internal temperature of meat and poultry can be a learning experience for cooks of all ages to ensure that their food is safe and not undercooked. "Using a food thermometer is the only way to tell if food has reached a high enough temperature to destroy harmful bacteria," said Dr. Elsa Murano, USDA Under Secretary for Food Safety. 

Today's food thermometers are user-friendly and come in various types. 
*       Instant-read thermometers come in dial and digital.  These are used after removing your food from the oven and give the temperature in a matter of seconds. 
*       Disposable temperature indicators are intended for one-time use and are handy for grilling or checking foods cooked away from home. 
*       Large dial thermometers, like a lot of people use with turkeys, are oven safe and remain in the meat while it's cooking so you can monitor its progress. 
*       Digital thermometers are a great gift for people fond of electronic devices.  One type is a digital probe that is inserted into the meat and attached to a long wire that connects to a base unit outside the oven.  It allows you to monitor the temperature while the meat is cooking.  You set the desired temperature and the unit beeps when it reaches that temperature. 

USDA recommends that for safety, beef, veal or lamb (roasts, steaks and chops) be cooked to an internal temperature of 145 °F for medium rare and 160 °F for medium. Fresh pork should reach 160 °F.  Whole poultry should reach 180 °F, as measured in the thigh.  Ground beef, veal and lamb should be cooked to 160 °F; ground poultry to 165 °F. 

Insulated carrying cases make great gifts for transporting either hot or cold perishables.  The insulated carriers come in various sizes and keep food at a safe temperature for approximately one hour. 

Programmable slow cookers are a new addition to the tabletop appliance line. Slow cookers heat food slowly at a low temperature -- usually between 170 and 280 °F.  The low, moist heat helps less expensive, leaner cuts of meat become tender.  The variety of temperature levels and cooking times allows you to cook your meal and then keep it warm without overcooking, even if you're running late. 

Color-coded cutting boards are great for preventing cross- contamination of foods. Dedicate some colors for cutting raw meat, poultry and fish, and different colors for cutting ready-to-eat foods such as salad ingredients, cooked meat and breads. These polyethylene plastic boards can be put into the dishwasher for sanitizing. Non-porous surfaces, such as plastic and tempered glass, are easier to clean than wood. 

Chafing dishes or food warmers are great gifts for party givers.  Perishable foods left out at room temperature can become unsafe after more than 2 hours; and 1 hour in temperatures above 90 °F.  Keeping hot food hot (140 °F or higher) in a dish with a heat source can prevent guests from getting foodborne illness. 

A larger, useful appliance is an electric roaster oven.  This tabletop electric cooker serves as an extra oven for cooking foods such as a turkey or large roast.  Generally the cooking time and temperature setting are the same as for a conventional oven. 

For the harried food handler, a kitchen timer makes a nifty little gift. Not only can it be used to remind cooks to check if something is done, it can also be used to remind cooks to put food away.  The USDA Meat and Poultry Hotline receives numerous calls from cooks who left food out to cool on the counter, only to discover it still sitting there the next morning. Perishable food is not safe if left out more than 2 hours; 1 hour in temperatures above 90 °F. 

USDA works to educate consumers on the importance of following food safety guidelines.  As a liaison to the Partnership for Food Safety Education, USDA supports the Fight BAC!® campaign which educates consumers on four simple steps that they can take to prevent foodborne illness: 

*       Clean - Wash hands and surfaces often. 
*       Separate - Don't cross-contaminate. 
*       Cook - Cook to proper temperatures. Use a food thermometer to make sure that your food has reached a safe internal temperature. 
*       Chill - Refrigerate or freeze promptly. 

For more information in English and Spanish, call the USDA Meat and Poultry Hotline at 1/888/MPHotline (1/888/674-6854); TTY: 1/800/256/7072.  The Hotline's hours are Monday through Friday, from 10 a.m. to 4 p.m., Eastern Time, year-round. An extensive selection of timely food safety messages is also available at the same number 24 hours a day.  Information can also be accessed on the FSIS Web site.
E-mail inquiries
 

Conference And Professional Training News

* The "Second Annual Symposium: Drug-Induced Hepatotoxicity Signal Detection: Practical Implications for Risk Management" was held on February 23rd - 24th, 2004 in Bethesda, MD. Visit Pharmaceutical Education Associates' for additional information. 

* The "International Conference on Women and Infectious Diseases" sponsored by the National Center for Infectious Diseases Centers for Disease Control and Prevention (CDC) was held on February 27-28, 2004 in Atlanta, GA. For more information, visit the web site. 

* "Nutrition in HIV Care Education and Training" for providers was held on March 8-11, 2004 in Los Angeles, CA. AIDS Project Los Angeles sponsors the event and space was limited. For additional information visit the web site. 

* The “3rd Annual Nutritionists In AIDS Care (NIAC) & HIV/AIDS Dietetics Practice Group (DPG) Conference: Comprehensive Management of Metabolic Complication in HIV” was held on March 13th, 2004 in New York City, NY.
NIAC and the HIV/AIDS DPG of the American Dietetic Association (ADA)  sponsored the conference. Session topics included “Current Trends & Treatment Options of Metabolic & Morphologic Complications in HIV/AIDS” presented by Gary Cohan, MD; “Emotional Impact of Lipodystrophy and Lipoatrophy” by Chuck Finlon, MSW; “Nutritional Healing: Integrative Approaches To HIV & Hepatitis C” by Jan Zimmerman, MS, RD; and “What's your RX Worth?: Exploring the Black Market for medications and nutraceuticals” by Jennifer Eliasi, MS, RD, CDN. 

* "Food as Medicine" was held on June 20-26, 2004 in Berkeley, CA. The Center for Mind-Body Medicine also offers "Transcripts for Comprehensive Cancer Care", which includes authoritative information about complementary and alternative therapies. 

HIV Nutrition Update - Newszine Issue 45

The Nov/Dec HIV Nutrition Update Newszine issue is now available. Along with other benefits, learning about HIV nutrition programs helps to increase awareness of available service locations. The feature article in this issue is authored by Sharon Ann Meyer, AS, AA, DTR, President of HIV ReSources, Inc., Editor- In-Chief of the HIV Nutrition Update, Nutrition Editor for NUMEDX journals and co-author of HIV Medications Food Interactions (And So Much More). The feature article adds to the limited knowledge available on programs providing nutritional services for people living with HIV/AIDS. It highlights data from 28 nutrition programs in various states within the U.S. and one program in British Columbia (BC), Canada surveyed from 1999 through 2003. These columns are also in Issue 45: 

* Update Central - information on diabetes and heart disease, which adds to that in previous HIV ReSource Review and HIV Nutrition Update issues; 
* Program Spotlight - PATH Center in Brooklyn, NY; 
* Resources - leads to diabetes and dietary supplement resources for clinicians and clients; 
* Med Watch - Actonel. 
 

Health, HIV/AIDS Resources

* The Body Pro offers complete access to free continuing education credit at CME/CE Central, authoritative next-day conference coverage, interactive "Ask Your Colleagues" forums, HIV/AIDS newsroom and a vast online treatment library. You can also receive bi-weekly newsletters via e-mail and/or fax with the latest news and information on HIV treatment, pathogenesis and epidemiology. 

* The Centers for Disease Control and Prevention (CDC) recently released a new data analysis "SMART BRFSS (Selected Metropolitan/Micropolitan Area Risk Trends from the Behavioral Risk Factor Surveillance System." The new analysis provides health information for 98 selected metropolitan and micropolitan statistical areas for 2002 in such health categories as diabetes, obesity, smoking and overall health status. SMART BRFSS includes a searchable Web site that features prevalence estimates for select risk factors for 2002. 

* ClinicalTrials.gov is an Internet data bank providing useful information on studies of drugs and biological products regulated by the Food and Drug Administration. The clinical trials web site, the world's largest source of clinical trial information, now lists a total of approximately 8,600 federally and privately sponsored trials throughout the U.S. and abroad. The data bank is authorized by the FDA Modernization Act, which requires drug companies and other organizations to make public their studies of experimental medications for serious or life- threatening diseases.

FDA notified more than 2,000 private sector drug sponsors of their legal obligation to promote data submission through a Web-based protocol- registration system. This system provides a straightforward and efficient way for sponsors to submit the information about their studies electronically. 

World AIDS Day Is December 1st

* Read "Why a red ribbon means Aids" and learn how the ribbon for AIDS awareness was born. 

* Visit Kaisernetwork.org for information on World AIDS Day including webcasts; news summaries; access to studies and key facts; and links to resources and organizations around the world. 
 

Nutritional Risk In HIV-positive People
By Charlie Smigelski, RD

Expert HIV nutrition care has never been more important. A third of HIV-positive people are still wasting. Nearly 80% have some diagnosable gastrointestinal malady, including: d-xylose (sugar) and fat malabsorption, and diarrhea. Many people are still at risk for malnutrition.

Metabolic complications like extremely high triglycerides and cholesterol levels are too common. Risk of diabetes and premature heart disease is mounting. These conditions exist despite, and somewhat because of, highly aggressive anti-retroviral therapy (HAART). Medicine is managing HIV, but metabolisms are out of control.

Lipodystrophy baffles too many clinicians and consumers. Facial thinning demoralizes patients. They feel that their HIV status is no longer invisible now. Fat accumulation in breasts, backs and abdomens frustrates all affected. Expert cholesterol treatment guidelines for lipid management are evolving, but often fall short of achieving adequate clinical results.

Toxic side effects of treatment are the reason that 50% of people discontinue their HAAART therapy. Durability of first anti-HIV therapy averages about 1 year; second course of treatment is often 7 months. This is unacceptable and unnecessary. Side effect management that includes nutrition care can be very useful. Supplements also improve drug treatment efficacy. More can be done to reduce toxicity, utilizing smart nutrition.

Good Nutrition is Potent Medicine

When a liver is fragile, dyslipidemia treatment for reducing heart disease risk with statins is often not an option. This is the case for many HIV/HCV co-infected people. However, nutrition therapy with nuts, seeds and fish oils can be extremely effective. Following the Food Guide Pyramid, on the other hand, is harmful for these people. Vegetarian diets of rice, beans, and tortillas are also trouble. Don’t let patients be misguided.

People with HIV are getting older. Chronic infection acts to accelerate ageing. Immune function slows with ageing, but good nutrition can ease the decline. Key amino acids, plus vitamins and minerals, fortify immune cells. HAART therapy also stresses some of these same nutrients. Common ageing conditions, like hypertension, osteoporosis and arthritis, compete for key nutrients. Poor diet can leave all these systems struggling. Then, malnutrition makes medical management more difficult.

HIV-positive people need an expert dietitian on their health care team. Food is the first medicine. People who are well nourished have fewer side effects. HIV-positive people deserve to know what the most immune-supportive diet is. Caveman Diet, a diet that meets our genomic expectation for nutrition, reduces heart attack risk by 76%, regardless of cholesterol numbers, and drops cancer risk. Besides immunologic and physiologic benefits, the food is great-tasting. Call it fish, roots, weeds, and nuts, but a supper of salmon with sweet potatoes, plus broccoli with macadamia nuts does the job. 

Nutritional supplements offer patients relief from a variety of debilitating side effects. Protracted anorexia and wasting are familiar to dietitians in critical care. In this circumstance, an HIV-experienced dietitian provides extra focus on nourishing liver and intestines, and results are dramatic. This can be the era of nutraceuticals. 

The nutritionist’s perspective on whole body metabolism is invaluable. A well-chosen antioxidant multivitamin offers the chance of diminishing mitochondrial toxicity in nerves and muscle. Enhanced antioxidant therapy raises glutathione, reversing wasting and extending life. When mitochondria are functional, fat is properly metabolized, and the condition that provokes insulin resistance is reduced. This whole body view diminishes lipodystrophy risk and magnitude.

"Eat Up Seminars: Medical Nutrition Therapy in HIV Care" designed by Charlie Smigelski, RD of Eat Up! in Arlington, MA is education for clinicians and advice for consumers. Seminars cover: HIV and Nutrition Basics; Treating Lipodystrophy; HIV Care for Case Managers; and HIV Nutrition for RD’s, RN’s, PA’s and MD’s. 

Charlie Smigelski, RD is a national voice in HIV nutrition care. He has been at Harvard University for 13 years. He previously co-edited the Tufts Medical School (HIV) "Nutrition For Healthy Living" newsletter, and worked at The Framingham Heart Study. For additional information on seminars visit the Eat Up web site.

All materials are protected by copyright and are the property of HIV ReSources or the parties credited as the provider of the content.
 

World AIDS Day 2003

HIV has hit every corner of the globe, infecting more than 54 million men, women and children, five million of them were infected last year. Women represent almost one in three new HIV infections in the U.S. Five people worldwide die of AIDS every minute of every day. 

World AIDS Day will be observed on December 1st and will feature activities around the world aimed at highlighting the HIV/AIDS epidemic. This year's theme for World AIDS Day is "Stigma and Discrimination". Wear the red ribbon to increase awareness of HIV and AIDS. Take a World AIDS Day quiz  to see how much you know about HIV general questions, statistic type questions, World AIDS Day, and other issues related to HIV and AIDS. 

"Are You HIV Prejudiced? Find out the facts about HIV/AIDS and read stigma and discrimination fact sheets by visiting the "Are You Prejudiced" web site. Download a PDF copy of their resource pack with information on numerous materials including fact sheets. 

"Investigating a Global Pandemic," is the BBC World Service network's biggest single-themed season that runs from November 16th through December 1st involving both radio and online programming. 

Visit the following web sites for more information on AIDS and HIV or to gather additional World AIDS Day resources: 

* AIDSinfo
* Office of Minority Health

Caring for Nutritional Needs 

Results from a study presented at the 9th European AIDS Conference (EACS) in Warsaw reports the leading cause for hospital admissions among HIV- positive people is heart disease. Cardiovascular disease is one of numerous known complications of antiretroviral therapy and hospital admission rates for conditions associated with antiretroviral therapy will likely continue until newer medications with fewer side effects are developed. Clinicians offering nutritional services to HIV- positive people must now be aware of medications used for the disease and must incorporate advice on how to deal with the effects of highly active antiretroviral therapy (HAART). 

Effective nutritional services includes successful management of bone disorders, lipids (HIV ReSource Review Issue 22 and Issue 23), and glucose abnormalities (Issue 27  and Issue 28). Nutritional care may be further complicated by the use of dietary supplements (Issue 21 and Issue 22) and recreational drugs (Issue 24 and Issue 25) that affect prescribed medications. Herb-drug interactions (Issue 28 and Issue 29) will continue to increase with increased use of botanicals. 
 

Food Recalls, Bacteria And Foodborne Illness

Many of our subscribers either donate food to food banks, work at food banks, or get foodstuffs from food banks so we think it is vital to know about these recent food recalls listed below. 

* Noris Farms of Oregon is recalling Organic Savory Cheddar Cheese because of possible Listeria monocytogenes contamination The organic savory cheddar cheese was distributed to Alberta Cooperative and The Daily Grind retail stores in Portland, Oregon. Consumers with questions may contact the company at 503/394-3273.

* Badgerland Meat and Provisioners in Wisconsin is recalling ground beef for possible E. COLI O157:H7. The ground beef and ground beef patties were distributed to restaurants in the Madison, Wisconsin area. Consumers and media with questions about the recall should contact the company president Pat Mackesey at 608/244-1934. 

* Abbyland Meats, an Abbotsford Wisconsin firm, is recalling fresh boneless beef products for possible E. COLI O157:H7. The products were shipped in containers of various weights and intended for further processing (grinding). The beef was produced on Oct. 20, 2003, and distributed to wholesale establishments in Wisconsin, Minnesota, Ohio, Illinois and Pennsylvania. Consumers with questions about the recall may contact Tiffiny Pierce at: 715/223-6386, ext. 7228. 

* Royal Baltic Ltd. of Brooklyn, New York has recalled smoked or cured fish products due to possible Listeria monocytogenes contamination. The salmon, herring in oil, and sea bass were distributed to retail stores in New York, New Jersey, Pennsylvania, Massachusetts, Connecticut, Illinois, Ohio, Virginia, and Maryland. Distribution also included one distributor in New Jersey who further shipped the Salmon, Sea Bass Variety Pack to the former Soviet states. For further information contact Vladimir Furleiter at: 718/385-8300. 

Updated information on Listeria monocytogenes is on the Internet at several locations:

* Risk Assessment Reinforces That Keeping Ready-to-Eat Foods Cold May Be the Key to Reducing Listeriosis

* Listeria monocytogenes Risk Assessment: Questions and Answers

* Listeria Infections

For additional information on bacteria and foodborne illness visit the National Institute of Diabetes and Digestive and Kidney Diseases. 
 

Bone Health Resources

Metabolic complications associated with antiretroviral therapy including bone disease are common occurrence in HIV-positive people. The October 2003 issue of the Office of Dietary Supplements Update adds to current information on bone health. The revised Vitamin A fact sheet now reflects new research published on vitamin A and osteoporosis. Several studies published in the last few years show that intakes of vitamin A above the recommended dietary allowance (RDA) may be harmful to bone health. The RDA of vitamin A for adult men and women is 900 mcg (3000 IU) and 770 mcg (2330 IU) respectively and the upper limit for all adults is 3000 mcg (10,000 IU). Access the revised fact sheet.

A new "Statement on Hormone Therapy for the Prevention and Treatment of Postmenopausal Osteoporosis" by the American College of Obstetricians and Gynecologists. 

See MEDLINEplus topic "Osteoporosis" for additional resources on bone health.

"Women’s Health Research for the 21st Century. Boning Up on Osteoporosis: Emerging Therapies for Prevention and Treatment" was held on Dec 9, 2003 between 1-3 p.m. in Masur Auditorium.

Update on Tea Consumption

As noted in "Tea, Diabetes, and Heart Disease", published in the Sept/Oct 2003 issue of the HIV Nutrition Update, adding tea in the diet can improve blood sugar control and significantly reduce blood cholesterol and the risk of cardiovascular disease. 

Investigators from the U.S. Department of Agriculture in Maryland continue to research the effects of black tea. A preliminary study of black tea in mildly hypercholesterolemic adults was recently published. Davies and colleagues note consumption of black tea lowered both total and low-density lipoprotein cholesterol in eight men and eight women with mildly elevated cholesterol. For additional information on tea consumption from the Proceedings of the Third International Scientific Symposium on Tea and Human Health visit the web site.

Canned Soup Recall

The U.S. Department of Agriculture's Food Safety and Inspection Service has announced that Del Monte Foods is voluntarily recalling canned soup because of an undeclared allergen (egg). The products being recalled are 19 oz. cans of "FOOD LION, Ready To Serve, CHUNKY GRILLED SIRLOIN STEAK WITH VEGETABLES." The soup cans actually contain "Chunky Grilled Chicken with Vegetables and Pasta" and the pasta contains egg whites. The soup was produced on July 24, 2003 and distributed to retail stores in Delaware, Florida, Georgia, Kentucky, Maryland, North Carolina, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia. Consumers who are allergic to eggs should not eat the soup, but should return it to the point of purchase. 

Media with questions about the recall should contact Melissa Murphy, Director of Public Relations, at 412/222-8713.  Consumers with questions about the recall may contact the recall information line at Del Monte Foods at 800/828-9980. Consumers with other food safety questions can phone the toll-free USDA Meat and Poultry Hotline at 1/888/MPHotline.  The hotline is available in English and Spanish and can be reached from 10 a.m. to 4 p.m. (Eastern Time), Monday through Friday.  Recorded food safety messages are available 24 hours a day.
 

Revised Guidance on Use of Food Labels

The Food and Drug Administration (FDA) has revised "Guidance on How to Understand and Use the Nutrition Facts Panel on Food Labels" to include information on trans fatty acids and placement of trans fat on the Facts Panel. This guidance provides consumers with information on how to use the nutrition label to make informed food choices that contribute to a healthy diet. This guidance in available in English and Spanish.

HIV/AIDS Nutrition Discussion Electronic Lists

* Discussion Group on Nutritional Care and Support for People Living with HIV/AIDS

ProNut-HIV aims to share up-to-date information, knowledge and experience on nutrition and HIV/AIDS. The discussion promotes constructive dialogue between HIV-positive people, front line workers, researchers, HIV/AIDS specialists and policy makers. The forum intends to focus primarily on the nutrition care and support of mothers and children. Send a message to ProNut-HIV to subscribe or unsubscribe, write to majordormo and in the body of the message type: subscribe pronut-hiv OR unsubscribe pronut-hiv. To contact a person, send a message. Information and archives are at the web site. 

* HIV Nutrition Discussion List 

The HIV Nutrition Discussion List is dedicated to issues surrounding nutrition and HIV and is sponsored by A1WebServer and HIV ReSources, Inc. It is open to anyone who chooses to subscribe. Only subscribers can post messages but messages can be freely shared with non-subscribers and are archived. To learn more or subscribe to the list visit the web site. 

HIV ReSources Web Site Update

10/21/03- The HIV ReSources Web Site is updated. 

New pages are at: 
HIV Nutrition Update Issue 44

New links are at: 
Networking, Toll Free Numbers And Resources

Ideal Ratio Of Registered Dietitians To Clients

Freebies, Movies & Game Links

HIV Information Links

Conferences, Updates, Online Classes, And Webcasts

Updated pages include: 
Nutrition Feature Abstracts - Issues 1-13

Mary Fisher's Address on AIDS
 

HIV/AIDS Resources

* The Winter 2003 edition of "Positively Aware" (nutrition issue) is available in Spanish. 

* The Henry J. Kaiser Family Foundation and The Jacobs Institute of Women’s Health offer "Women’s Health Data Book: A Profile of Women’s Health in the United States". Individual copies of this publication (#6004) may be obtained by calling the Foundation's publication request line at 800/656-4533. Multiple copies may be obtained from the Jacobs Institute by calling 202/863-4990. 

* "Health Care and HIV: Nutritional Guide for Providers and Clients" is available online. 

Post-Publication News - Leptin And Adiponectin

Recently published information on leptin and lipodystrophy adds to that found in the Update Central column published in Issue 41 of the HIV Nutrition Update. Increasingly more sources are noting that leptin may play a role in HIV-related lipodystrophy. 

Murine studies suggest that leptin replacement therapy may help to reduce metabolic abnormalities associated with the treatment of HIV by highly active antiretroviral therapy (HAART). (1) Murine studies of leptin treatment also suggest that insulin up-regulates and leptin down-regulates adipocyte fatty acid uptake, leading to alterations in fatty acid partitioning that affect fat cells. (2) 

Lipodystrophy patients have significantly reduced plasma leptin levels and leptin replacement therapy may reduce hepatic fat mass and improve insulin sensitivity. (3) Preliminary studies by Nagy and colleagues working in Boston report that after controlling for total and regional body fat, significantly reduced leptin levels in HIV-positive patients with lipoatrophy were independently associated with insulin resistance. (4) Sutinen and others report the severity of insulin resistance in HAART patients correlates with fat accumulation in the liver. (3) Investigators note leptin-induced improvements in insulin sensitivity accompanied by reductions in intrahepatic and intramyocellular lipid accumulation. (5) 

We know that leptin plays a role in energy homeostasis and now investigators are attempting to determine if it influences bone development and remodeling. Preliminary data from two women showed that subcutaneous leptin replacement therapy had no effect on bone in hypoleptinemic patients with generalized lipodystrophy. (6) 

Adiponectin is a fat cell-secreted protein that acts to increase insulin sensitivity. As in a murine model of lipodystrophy, patients on HAART with fat redistribution may have decreased levels of adiponectin. (7) In some HIV- positive patients treated with HAART, adiponectin is directly correlated with high- density lipoprotein cholesterol and extremity fat and inversely correlated with abdominal visceral fat mass, serum triglycerides, and insulin resistance. Addy and others note the use of non- nucleoside reverse transcriptase inhibitors may worsen insulin resistance by decreasing adiponectin levels. These investigators report that adiponectin treatment improves metabolic syndrome in adiponectin deficient mice. Although there may be a link between adiponectin, central obesity and insulin resistance there is no association between serum adiponectin and leptin. (8) Gavrila and colleagues report that neither fasting for two days, which results in a low leptin state, nor leptin administration alters
serum adiponectin levels in women without a known history of diabetes. 

References 
1. Riddle TM, et al. Leptin Replacement Therapy but not Dietary Polyunsaturated Fatty Acid Alleviates HIV Protease Inhibitor-Induced Dyslipidemia and Lipodystrophy In Mice. JAIDS 2003;33(5):564-70. 
2. Fan X, et al. Leptin and Insulin Modulate Nutrient Partitioning and Weight Loss in ob/ob Mice through Regulation of Long-Chain Fatty Acid Uptake by Adipocytes. J Nutr 2003;133:2707-2715. 
3. Sutinen J, et al. Increased Fat Accumulation in the Liver in HIV-Infected Patients with Antiretroviral Therapy-Associated Lipodystrophy. AIDS 2002;16(16):2183-93. 
4. Nagy GS, et al. Human Immunodeficiency Virus Type 1 Related Lipoatrophy and Lipohypertrophy Are Associated with Serum Concentrations of Leptin. CID 2003;36(6):795-802. 
5. Simha V, et al. Effect of Leptin Replacement on Intrahepatic and Intramyocellular Lipid Content in Patients With Generalized Lipodystrophy. Diabetes Care 2003;26(1):30-35. 
6. Simha V, et al. Effect of Subcutaneous Leptin Replacement Therapy on Bone Metabolism in Patients With Generalized Lipodystrophy. J Clin Endocrinol Metab 2002;87(11):4942-5. 
7. Addy CL, et al. Hypoadiponectinemia is Associated With Insulin Resistance, Hypertriglyceridemia, and Fat Redistribution in Human Immunodeficiency Virus-Infected Patients Treated With Highly Active Antiretroviral Therapy. J Clin Endocrinol Metab 2003;88(2):627-36. 
8. Gavrila A, et al. Serum Adiponectin Levels Are Inversely Associated With Overall and Central Fat Distribution but Are Not Directly Regulated by Acute Fasting or eptin Administration in Humans: Cross-Sectional and Interventional Studies. J Clin Endocrinol Metab 2003;88(10):4823-31. 

Editors Note: Although we focus on nutrition and HIV related issues the fight for affordable medications appears worth mentioning as it affects everyone. If you find the cost of prescribed medications unjustly high please view the Fight For Affordable Drugs Web Site. 

HIV/AIDS Resources

* Live help is now available at the AIDSinfo web site. Live Help provides confidential, one-on-one assistance Monday through Friday from 12 p.m. to 4 p.m. Eastern Time. Visit the AIDSinfo web site; email; or telephone: 800/448-0440; International: 301/519-0459; TTY/TDD: 888/480-3739 for Federal HIV/AIDS information on clinical research, HIV treatment and prevention, and medical practice guidelines for health care providers and consumers. 

* The July 2003 issue of the "Canadian Adverse Reaction Newsletter" published by the Marketed Health Products Directorate is now available. Information on Gatifloxacin (Tequin) side effects of hypoglycemia and hyperglycemia adds to information published in the July/Aug 2002 issue (Issue 37) of the HIV Nutrition Update. 

Post-Publication News 
* Complimenting information found in HIV Nutrition Update Issue 44, a recent article notes that consumption of black tea reduces both total and low-density lipoprotein cholesterol in mildly hypercholesterolemic adults. Consumption of black tea is also inversely related to blood pressure in older women. 

* A recent publication adds to the information on guggul published in HIV ReSource Review Issue 27 of the HIV ReSource Review. Szapary and others report that in a small double-blind, randomized, placebo-controlled trial, guggul extract failed to lower abnormal cholesterol levels. In the eight-week study, participants took standardized guggul extract (2.5% guggulsterones) or a matching placebo three times a day.

* Numerous people living with HIV/AIDS have vitamin B12 deficiency. An article in the New England Journal of Medicine on neurologic manifestations of vitamin B12 deficiency adds to information published in HIV ReSource Review  Issue 21. Also, Campbell and colleagues report that serum gastrin concentrations and crystalline vitamin B12 intake may predict plasma vitamin B12 concentrations. 

Food Recalls

* M.D. Chavez/Old Santa Fe Trail, an Albuquerque, New Mexico firm, is voluntarily recalling beef jerky that may be contaminated with Salmonella. These products were distributed to retail stores and through mail order nationwide and sold through a vendor at the New Mexico State Fair. 

* Bingham Hill Cheese Company of Fort Collins, Colorado has recalled Rustic Blue Cheese due to possible Listeria monocytogenes contamination. The cheese was distributed in Colorado, Manhattan (NY), San Franscisco Bay area (CA), Chicago (IL), Houston (TX), Minneapolis (MN), Portland (OR), Santa Fe (NM), Miami (FL), Palm Springs (CA), Iowa City (IA), Laramie (WY), Cheyenne (WY) and Atlanta (GA). In Colorado, the cheese was distributed to farmers' markets in Boulder, Fort Collins, Minturn, Dillon, Breckenridge and Colorado Springs. In Wyoming, the cheese was distributed to farmers' markets in Laramie and Cheyenne. Further Information
 

HIV Nutrition Update - Newszine Issue 44

Learning more about complementary treatments is vital as increasingly more HIV-positive people incorporate Eastern Medicine into their treatment routines. The Institute of Science in Society offers a short article on Traditional Chinese Medicine and Contemporary Western Science that compliments the information found in our series on Chinese Medicine. Although many people believe more research is needed to support the claims currently being made, at least 12% of Americans use herbal medicines. Western research methods are now being used to evaluate the role of herbal medicine in conventional treatment programs.

The Sept/Oct  HIV Nutrition Update Newszine issue is now available. The feature article in Issue 44 is authored by Senior Editor Richard A. Freiberg, D.O.M., D.Ac., A.P., Board Certified Diplomate. The article furthers our knowledge of Oriental Medicine, specifically on the practice of moxibustion. Issue 44 also includes additional information on the published work of the National HIV Nutrition Guidelines Working Group. These columns are also in Issue 44: 

* Update Central - subjects include information on the use of omega-3 fatty acids and tea for heart disease and diabetes and a clinical trial update on long-term nonprogressors; 
* Program Spotlight - Broadway House for Continuing Care in Newark, NJ; 
* Resources - leads to resources for clinicians and clients; 
* Med Watch - WelChol; 
* Product Update - disposable cutting sheets, Diabetishield, Healthy Habits program and Vitamite 100. 

Food and Drug Administration (FDA) News

The Ariza Cheese Company has recalled Cotija Cheese due to possible contamination with Listeria monocytogenes.

FDA recently issued an advisory on Star Anise "Teas" noting that consumers should not consume "teas" brewed from star anise. Brewed "teas" containing star anise have been associated with illnesses affecting about 40 individuals, including approximately 15 infants. The illnesses, which occurred over the last two years, ranged from serious neurological effects, such as seizures, to vomiting, jitteriness and rapid eye movement.

Although the labeling of "teas" that contain star anise does not make claims for the product, FDA understands that these products are popularly believed to help against colic in infants. FDA is unaware of scientific evidence to support benefits from "teas" brewed from star anise. Given that fact, consumers should not use them or give them to infants and children. 
 

Managing Effects of HAART

As noted in previous issues of the HIV ReSource Review and HIV Nutrition Update, treating dyslipidemia in HIV-positive people includes following National Cholesterol Education Project (NCEP) standards. Guidelines for treating dyslipidemia reflecting updated NCEP standards were recently published in the Clinical Infectious Diseases (CID) journal. The new guidelines compliment information offered in previous HIV ReSource Review and HIV Nutrition Update issues by reviewing information on antiretrovirals and therapeutic treatments to lower cholesterol levels. The recently published CID article is available at the CID and National AIDS Treatment Advocacy Project web site. 

HIV ReSources Web Site Update 
9/29/03 

The HIV ReSources Web Site is updated. 

New links are at: 
Search Engines

National HIV Nutrition Guidelines

Why Be Tested For HIV?

Wasting And Weight Loss Information

Conference Information

Agenerase Alert
 

Food Safety

September is National Food Safety Education Month. National Food Safety Education Month is sponsored by the National Restaurant Association Educational Foundation's International Food Safety Council, an initiative focused on heightening the awareness of the importance of food safety education to the restaurant and foodservice industry and supported by many public and private sector organizations. The theme this year is "Store It. Don't Ignore It." For help with planning 2003 activities, visit the following web sites: 
2003 National Food Safety Education Month and National Restaurant Association Educational Foundation.

Government agencies now offer information on how to handle food and water during emergency situations. Knowing how to determine if food and water are safe and how to keep them safe will help minimize the potential loss of food and reduce the risk of foodborne illness. This information will help you make the right decisions for keeping your food and water safe during an emergency. Further information

To limit the incidence of foodborne illness visit the Handwashing Links page, which lists curricula, videos and other teaching materials; web sites; guides, fact sheets and manuals; signs, posters and forms; slides and videos; and searches from the PubMed and AGRICOLA databases. Other food safety resources include: 

* Bag Lunches English
* Spanish
* USDA/FDA Foodborne Illness Education Information Center
* Food Safety Newsletters
* Non-English Food Safety Resources

Food Recalls

The following products are being recalled for the reasons shown. Go to the Food and Drug Administration web site for more information. 

* Golden Luck Inc. Red Pepper Powder; 1.4-oz. bottles (possible Salmonella contamination) 

* Food Connection II Seafood Salad (possible Listeria monocytogenes contamination) 

* South Mill Gourmet Slices -- mushrooms (possible Listeria monocytogenes contamination) 

* Nut Boy Co. Tropics Mix and Banana Nut Trail Mix; 16-oz. packages (undeclared sulfites) 

* Roxy Trading Inc. Dried Guava Slices (undeclared sulfites)

* HDCC International Dried Guava Slices (undeclared sulfites)
 

Complementary And Alternative Health Care

Complementary and alternative medicine use is prevalent in our society. (1, 2) As noted in HIV ReSource Review Issue 21, people living with HIV infection consider complementary therapies an important part of treatment and care. (3) It's critical that policymakers and public health care workers gain an understanding of how integral complementary and alternative health care is to public health. The use of complementary and alternative medicine (CAM) continues to increase throughout the world and is associated with several sociodemographic, clinical, and attitudinal variables. (4) Data from the HIV Cost and Service Utilization Study reveals that 15.4 % of people receiving regular medical care for HIV had seen an alternative therapist in the past six months. Fifty-four percent with at least one visit had five or fewer visits in six months. HIV-positive people were more likely to see an alternative therapist if they were white, gay/lesbian, had a higher income, were depressed, and wanted more information and involvement with their own health care. 

Provision of CAM may be further increased as a result of the proposed modification to the coding standards for the nations healthcare transactions. The U.S. Department of Health and Human Services recently authorized the test of Advanced Billing Concept (ABC) codes for products and services delivered by integrative healthcare practitioners. (5) The ABC codes will fill gaps in the American Medical Association Healthcare Common Procedure Coding System (HCPCS) Level I codes (CPT codes) and CMS HCPCS Level II codes. The ABC codes should also help to compare the quality and cost-effectiveness of different approaches to healthcare including conventional, complementary and alternative practices. The testing of ABC codes creates an exception to current Health Insurance Portability and Accountability Act (HIPAA) regulations. Currently, the ABC codes are not supported by widespread insurance reimbursement. 

Coordination of care can help medical and CAM care providers to increase their understanding of CAM effects on treatment outcomes. Ways to help HIV-positive people remain well include: 

* Ask about supplement and herb use. 
* Discuss the harm:benefit ratio with dietary supplement users and encourage supplement users to investigate complementary therapies by contacting companies to ask specific information. 
* Keep medical care and CAM providers informed. 
* Keep files on herbs and other alternatives along with good reference materials to assist you in supplying your patients or clients with accurate information. 

For additional information on ABC codes and complementary therapies visit the Alternative Link, and the Acupuncture & Oriental Medicine National Coalition. 

References
1. McFarland B, Bigelow D, Zani B, Newsom J, et al. Complementary and Alternative Medicine Use in Canada and the United States. Am J Public Health 2002;92(10):1616-1618. 
2. Rafferty AP, McGee HB, Miller CE, Reyes M. Prevalence of Complementary and Alternative Medicine Use: State-Specific Estimates From the 2001 Behavioral Risk Factor Surveillance System. Am J Public Health 2002;92(10):1598-1600. 
3. Spaulding-Albright N, Meyer SA. Botanical Use Among People Living With HIV: Part One. HIV ReSource Review, Newsletter. 1999; 4(3): 1-3, 11-13, 22. 
4. London AS, Foote-Ardah CE, Fleishman JA, Shapiro MF. Use of Alternative Therapists Among People in Care for HIV in the United States. Am J Public Health 2003;93(6):980-987.
5. Testing Of ABC Codes Approved For Complementary And Alternative Medicine And Nursing. NPI Center January 30, 2003.