I am on the faculty in the Dept. of Food Science -&- Human Nutrition at the University of Hawaii.  From time to time I have students who are interested in nutrition -&- HIV/AIDS and possibly working in that area after graduation.

I am always interested in certifications that can facilitate specialization.  The "Certified HIV Counselor" sounds like such a certification.  I would appreciate any assistance you can provide  to help me find out more about this certification. Thanks. Alan

Subject: re: Certified HIV Counselor
Date:     Tue, 13 Feb 2001 16:18:45 -0800 (PST)
From: HIV Nutrition Discussion List

Hello Alan,
A certified HIV Counselor is taught how to perform both pre and post-test counseling to people who are interested in getting tested for the HIV virus. I found the class somewhat helpful in  learning about counseling techniques but think it would be very helpful to someone without any previous class work in counseling. 

At the time I got my certification, which was a number of years  ago (see my CV for the date if you are interested), several agencies held classes. Local hospitals, the Red Cross and ASO's had periodic classes that were a week long. In order to qualify for the classes you had to have already had experience in the field (I think it was at least a year - the people in my class all had more than 3 years) and be up-to-date with AIDS education (AIDS 101, etc.). I have heard that, in Florida, the state is working on developing methods to ensure that certified counselors are kept up-to-date through CEUs. Students interested in getting certified could start by contacting local hospitals, the area Red Cross and a few ASOs to see if there are classes available. Last time I heard about the classes the cost had went up to around $300.

DaveyBoy 

NOTE: The site is no longer operational as of 1/17/06

I need information on any hiv/Aids chat rooms/support groups online.

Re: Chat Groups
Date:  Sun, 23 Apr 2000 20:58:24 -0700 (PDT)
From: HIV Nutrition Discussion List 

Follow these links to find the information you seek:
Toll-Free Information Links
The Body

re: Chat Groups
Date: Mon, 24 Apr 2000 10:46:56 -0700
From: HIV Nutrition Discussion List

Many of my clients go to this site:
HIV Living

I am putting together a cooking class series to be delivered at an AIDS food bank. We have no cooking facilities at present and will bring in minimal, i.e. microwave, hot plate, grill etc.., to do the classes. I have read about others doing cooking classes through publications and the DPG online network. My question is: Does anyone have a template for a cooking class series for food bank folks? How well received are the classes? Would you be willing to share any templates/information?
Thanks for any input.

Chris Mason, R.D. - The Center for HIV Prevention and Care - Sonoma County, CA
 

Subject:  Re: Cooking Classes
Date:       Fri, 31 Mar 2000 19:27:25 -0800 (PST)
From: HIV Nutrition Discussion List 

Relative to the cooking classes, have you thought of contacting the Second Harvest organization? I know our local food bank has a program where chefs come to the food bank and teach classes. There is also a program called Share our Strength, where a chef and nutritionist teach together. Good Luck. Liz C, RD
 

Subject:      Re: Cooking Classes
Date:          Fri, 31 Mar 2000 20:36:34 -0800 (PST)
From:         HIV Nutrition Discussion List

Hi, I would be happy to help you develop or update a class. I am just finishing up my culinary training. Please let me know if I can help you in any way.
Stephanie Green, RD
 

Subject: re: cooking classes
Date:     Wed, 5 Apr 2000 14:59:50 -0700 (PDT)
From:  HIV Nutrition Discussion List 

I have been conducting cooking/nutrition classes every week for the last 1 1/2 years at the Bridge Project.  This Project place  those with triple diagnosis (HIV, mental illness, homeless) in local SRO's and provides a wide range of services to assist them with "getting on their feet" and taking care of their health. 

Most have no cooking or storing facilities.  If they have anything, its a hotplate or electric fry pan.  Needless to say, my cooking tools consist of a hotplate, a fry pan from Goodwill, and a wooden spoon. Unfortunately, I have no template because I work with the food that is available each month at Project Open Hand food bank (all my clients shop there). The menu at the food bank changes monthly and I only know what is avaiable at the beginning of each month. I keep the recipes simple and with few ingredients (always providing copies for clients).  Some recipes are hot and others are cold. I have also let clients develop their own recipes and cook for the group. 

As we are preparing the food, we are discussing nutrition topics like food safety, priority foods to buy, protein foods, what to choose at fast food places or the local "mom and pop" grocery store, play food bingo, etc. I bring nutrition ed materials that are already developed. These groups are very popular.  Anywhere from 5-25 clients will show up in a given week (lower show rate at beginning of month). 

Hope that helps, Chris. Let me know if you have any questions. 
Lisa McMillan, RD - Department of Public Health - CARE Nutrition Program
 

Subject:  Re: cooking classes for special needs gr
Date:      Mon, 10 Apr 2000 21:45:29 -0700 (PDT)
From:   HIV Nutrition Discussion List

"Stir it Up" is a video by the National Film Board (Canada) about community kitchen movement. Most Health units seem to have  resource materials for starting a community (collective ) kitchen.  Here we also have a coordinator of community kitchens who has managed to get about 10 going in a small  (50,000) city.
Martha Munz Gue - Medicine Hat College
 

Date:  Mon, 29 May 2000 17:38:11 -0700 (PDT)
From: HIV Nutrition Discussion List

The Toronto People With AIDS Foundation offers several sessions of cooking classes throughout the year. The classes are held off-site at a local community centre weekly. Topics include items like, what to make with what you get from foodbanks, nutrition, etc. Occasionally speakers from organizations like public health join in and offer hints -&- tips on where to get foods and what can be done with them. For more information contact Thomas. 
Mark Blans - Board of Directors - Toronto People With AIDS Foundation

I am a clinical instructor at FIU.  A student mentioned HAART in an oral report about a patient who had HIV.  No one in the class could translate the letter meaning. If you could decrease my ignorance, I would really appreciate your help! Thanks Mary Brenner

Subject: Re: Definition of HAART
Date:   Wed, 19 Apr 2000 09:07:40 -0700 (PDT)
From:  HIV Nutrition Discussion List 

HAART is short for highly active antiretroviral therapy, which includes at least one protease inhibitor and usually two other antiretroviral drugs. This type of treatment greatly decreases HIV progression but not without serious side effects such as heart disease and diabetes. Review some of the abstracts on this web site.
Sharon Ann Meyer

Does anyone have a recommendation for a good video that deals with nutrition for AIDS patients that would be good for a senior level diet therapy class?  If you know of one, do you know where I could purchase it? Thanks
Susan S. Swadener, Ph.D., R.D. 
 

Subject: Re: HIV/AIDS video on nutrition
Date:     Tue, 4 Apr 2000 10:53:12 -0700 (PDT)
From:    HIV Nutrition Discussion List

We made two 1/2 hour nutrition videos on HIV at the Fenway Health Center, Boston. 1st one is simple eating and cooking suggestions,  2nd one is mock counselling sessions, on diarrhea, neuropathy, etc. A class could discuss issues raised in the counselling session, e.g use of glutamine and probioics in diarrhea; C-Q10 for energy and immune cell fuel. The videos were made for local access TV broadcast. Contact Marshall Miller at Fenway Community Health, Boston.
Charlie Smigelski, RD
 

We just found out that my husband is HIV positive. I am HIV negative. What should we do to keep me HIV negative?

For starters, visit these the HIV ReSources web site Search Engines to search for information.  I did a search for "discordant couples" and came up with numerous sites at Medscape

I'll let you know when I get any specific information if you like. I will not keep your email address until you email me back to let me know you'd like the new information.

There are also bulletin boards where you can post your questions without identifying yourself. Check  previous messages for the topic at the main archive page. 

Most importantly, visit The Basics - Day One at AEGIS. It is a great resource for people who have recently learned of their HIV+ status.

It would be helpful for you both to get involved with a support group so you can discuss your situation and learn of ways to deal with it and get the support you need.
Sharon Ann Meyer

Please post and share this info on a support group. It's an HIV+ Mixed Hetero support group that currently meets the 2nd and 4th Wednesday evenings at 5:30 PM in South Minneapolis. This group was started in March of 2000. We have a good turn out for each meeting. The mix is roughly half male and female. This is a peer support group which is facilitated by a Social Worker from Clinic 42 of Abbott Hospital. We have no set agenda for our meetings. Our meetings are a very safe way of getting to know, share resource information and support each other. Besides the regular meetings we also go to plays and concerts etc. together. They have a web site.
Thank you  very much! Yuri
 

The HIV/AIDS Search Engine now available in 25+ Languages where you will find the following World languages: Spanish, Russian, Deutsch, Italian, Norsk, Portuguse, Bulgarian, Czech, Chinese, Japanese, Korean, German, Norwegian, Arabic, Hungarian, Finnish, Icelandic, Filipino, Polish, Romanian, Serbian, Slovenian, Welsh, Turkish, Greek, English and French (more coming soon). This makes this a fully international site now. Please feel free to add non English Websites (HIV/AIDS sites only).

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Visit the web site also for all your up-to-date HIV/AIDS NEWS on trials, vaccines, recent break throughs, side effects, recalls, discoveries, etc...

A Power Search tool to research the internet for HIV/AIDS Info on the top 125 search engines.

Everyday I add something new! POZ for POZ DaveyBoy

I listen to a nationally syndicated health show hosted by a physician named Dean Edell.  Someone called in saying that many meth labs have been busted in recent weeks/months in his area.  Evidently 55 gallon drums of human urine have been found at some of the labs.  The people who ran the meth labs have supposedly been extracting whatever amounts of meth residue that were in the urine.  Also, traces of HIV were found in the urine, according to published reports.  The caller wanted to know if HIV can be spread through the making and distribution of new meth.

Dr. Edell admitted he didn't know much about this, but he said that urine is fairly clean (e.g. not many germs) and viruses and germs usually have a hard time surviving in an acidic environment and sticking to the walls of the bladder, etc.  I'm sure the caller is reporting what the media reported.  If all of this is true, can HIV survive in urine, and if so, can it be spread through the making of new drugs?  Thanks.
Kevin
 

I don't know all the steps involved in making meth, however if it involves high temperatures it is doutful that HIV could still survive in the urine.
Sharon Ann Meyer

A second question I have addresses the information about lipodystrophy and the differentiation being made between PIs and NNRIs. Has anyone been seeing insulin levels on persons taking PIs who have characteristic features: central visceral adiposity, dorsocervical fat pad, peripheral wasting, no significant weight loss, hyperlipidemia? And, has anyone been tracking/testing lactic acid levels on individuals taking NNRIs with wt loss, significant fat mass losses without visceral adiposity/ dorsocervical fat pad? If so, is metformin helping the first group and what treatment is being used for the second? Thanks for any input.

Chris Mason, R.D. - The Center for HIV Prevention and Care - Sonoma County, CA

I don't have the answers. I am not in a situation where we order those tests right now. I spoke with an RD from Bellevue and they are measuring glycosylated hemoglobin at their institution. I have also heard that a medical practice in Cabrini-Liberty Medical is measuring lactic acid and finding elevated levels- they are prescribing Carnitor and B complex for their patients- I don't have any outcome data though on either of these practices.
Donna Tinnerello, MS, RD

"Various Mechanisms Responsible for Lipodystrophy in HIV- Infected Patients" - Reuters Health (08.22.01)

Most studies of lipodystrophy in HIV-infected patients have  emphasized a connection between antiretroviral therapy, while some have suggested that lipodystrophy is associated with HIV-1 
disease stage, baseline viral load or pre-existing alterations in body fat distribution. Recently, however, French researchers reported that factors such as HIV-1 load and age, as well as antiretroviral therapy with or without protease inhibitors, are linked with the development of lipodystrophy among HIV-1 infected patients. The researchers, whose findings were published in the July/August issue of HIV Clinical Trials (2001; 2: 339-345), said many questions about the association between lipodystrophy and HIV-1 infection are still unanswered. 

According to Dr. Faroudy Boufassa and colleagues, "Particular factors have been thought to cause this syndrome [lipodystrophy]. But the evidence points to a multifactor origin." Boufassa's group conducted a cross-sectional study of 685 HIV-1 infected men and women who were receiving outpatient antiretroviral treatment at six Paris hospitals between January and May of 1999. Clinical lipodystrophy was diagnosed in 58.8 percent of patients. Of these, 64 percent were receiving protease 
inhibitors, while 40.9 percent had never received them. 

Multivariate analysis revealed that older age, low HIV RNA level at assessment, duration of antiretroviral therapy, and treatment with antiretroviral combinations that included protease inhibitors or stavudine, were independent predictors of lipodystrophy. Identifying the role of the various mechanisms involved in lipodystrophy is crucial to finding ways to reduce the risk of cardiovascular disease, which is likely to be increased in HIV-1 infected patients with lipodystrophy.

Subject:  re: Lipodystrophy
Date: Thu, 30 Aug 2001 09:50:40 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

The Body and Medscape have numerous articles that compliment our previously published articles on lipodystrophy. Also, from the AIDS Digest there is: Hadigan C, Grinspoon S. Insulin Resistance in HIV Lipodystrophy Syndrome. AIDS Clinical Care Feb 2001;13(2):1. Researchers recently completed a study identifying the incidence of insulin resistance in HIV-patients who exhibit signs of lipodystrophy.
The authors noted two significant metabolic changes occurring in those patients, including significant insulin resistance and hyperlipidemia linked to fat redistribution.  The characteristic bunching of metabolic abnormalities, as exhibited by fasting hyperinsulinemia in relationship to normal fasting glucose levels, results in a high insulin resistance condition and may also place HIV-infected lipodystrophy patients at a higher risk for cardiovascular disease (CVD).   Another significant factor for CVD risk is the weight gain associated with HIV-related lipodystrophy and insulin resistance.  There are insulin-sensitizing drug compounds currently being used to combat the metabolic changes
brought on by the condition, but further clinical trials are recommended to determine the long-term effects of the treatment.  The researchers feel that until more is understood about the condition, clinicians should recommend a treatment program based on modified diet, exercise, and weight management for patients with HIV-associated lipodystrophy.
 

FYI: From Unwin N. Definitions of the Metabolic Syndrome. JAMA, Vol. 289 No. 10, March 12, 2003

                                           To the Editor: In their prospective cohort study, Dr Lakka and
                                                colleagues1 found that men with the metabolic syndrome were at
                                                greater risk of cardiovascular disease (CVD) and all-cause mortality,
                                                even if they did not have CVD or diabetes at baseline. Further
                                                analyses are required, however, before the real prognostic value of the
                                                metabolic syndrome can be assessed.

                                                A central issue is what is gained and what is lost by categorizing
                                                individuals as having the metabolic syndrome compared with
                                                assessing their risks on the basis of combinations of individual risk
                                                factors. Although low-density lipoprotein cholesterol, smoking, and
                                                family history of coronary heart disease (CHD) were controlled for in
                                                the analyses, low levels of high-density lipoprotein cholesterol and
                                                hypertension (both included in the definition of the metabolic
                                                syndrome) are also established risk factors for CVD. Although the
                                                authors excluded from one of their analyses participants with impaired
                                                fasting glucose levels, this nonetheless would have left a substantial
                                                number with impaired glucose tolerance.2

                                                Furthermore, the metabolic syndrome is a heterogeneous category.
                                                For example, according to the National Cholesterol Education
                                                Program (NCEP) definition,3 2 individuals with the syndrome may
                                                share as few as only 1 feature. A recent report has found that different
                                                components of the syndrome (defined using factor analysis) had
                                                different risks for the development of diabetes,4 and it is very plausible
                                                that this also will be the case for CVD. Thus, grouping individuals
                                                together into the category of the metabolic syndrome may entail a
                                                loss, possibly substantial, of predictive information.

                                                Nigel Unwin, MD. Diabetes and Paediatric & Life-course Epidemiology
                                                Research Groups, Medical School, University of Newcastle,
                                                Newcastle, England

                                                1. Lakka H-M, Laaksonen DE, Lakka TA, et al. The metabolic
                                                syndrome and total and cardiovascular disease mortality in
                                                middle-aged men. JAMA. 2002;288:2709-2716. 

                                                2. Unwin N, Shaw J, Zimmet P, Alberti KG. Impaired glucose
                                                tolerance and impaired fasting glycaemia: the current status on
                                                definition and intervention. Diabet Med. 2002;19:708-723. 

                                                3. Adult Treatment Panel III. Executive Summary of the Third Report
                                                of the National Cholesterol Education Program (NCEP) Expert Panel
                                                on Detection, Evaluation, and Treatment of High Blood Cholesterol in
                                                Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497.

                                                4. Hanson RL, Imperatore G, Bennett PH, Knowler WC. Components
                                                of the "metabolic syndrome" and incidence of type 2 diabetes.
                                                Diabetes. 2002;51:3120-2127. 
 

                                            To the Editor: Dr Lakka and colleagues1 tested both the NCEP
                                                classification of the metabolic syndrome, as well as a modification
                                                suggested by a World Health Organization (WHO) working group.
                                                Unlike the modified WHO definition, the NCEP definition did not
                                                predict cardiovascular mortality. Although the original WHO definition
                                                measured insulin resistance by the euglycemic hyperinsulinemic
                                                clamp and/or impaired glucose regulation, Lakka et al instead used
                                                fasting serum hyperinsulinemia as a surrogate. They also changed
                                                the blood pressure cutoff from 160/90 mm Hg to 140/90 mm Hg, and
                                                omitted microalbuminuria.

                                                It would be of interest to compare the differences in prevalence of the
                                                metabolic syndrome by using these definitions, especially with regard
                                                to the occurrence of insulin resistance, which seems to be a key
                                                component in the metabolic syndrome. We used data from a
                                                previously published study of 104 men who were examined with the
                                                clamp method.2 In this sample the proportions of subjects fulfilling the
                                                criteria for the metabolic syndrome were 27% (original WHO
                                                definition), 22% (modified WHO), and 28% (NCEP), respectively, and
                                                14% of the men met the criteria for all definitions. Three percent of the
                                                men fulfilled the modified WHO criteria but did not fulfill the original
                                                WHO criteria; none of those were insulin resistant. Nine percent of all
                                                men, or almost one third of those fulfilling the NCEP criteria, did not
                                                meet the WHO criteria based on insulin resistance as measured by
                                                clamp.

                                                In a previous Finnish study, the WHO criteria were found to predict
                                                cardiovascular mortality.3 Thus, at least 2 previous studies have
                                                shown the predictive value of the WHO definition. The findings of
                                                Lakka et al indicate that the NCEP definition has less predictive
                                                value. It is possible that this is due to the absence of any criterion
                                                reflecting insulin resistance.

                                                Carl Johan Behre, MD, Björn Fagerberg, MD, PhD
                                                Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska 
                                                University Hospital, Göteborgs Universitet, Göteborg, Sweden

                                                1. Lakka H-M, Laaksonen DE, Lakka TA, et al. The metabolic
                                                syndrome and total and cardiovascular disease mortality in
                                                middle-aged men. JAMA. 2002;288:2709-2716. 

                                                2. Bokemark L, Wikstrand J, Attvall S, Hulthe J, Wedel H, Fagerberg
                                                B, for the Atherosclerosis and Insulin Resistance Study (AIR). Insulin
                                                resistance and intima-media thickness in the carotid and femoral
                                                arteries in clinically healthy 58-year-old men. J Intern Med.
                                                2001;249:59-67. 

                                                3. Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and
                                                mortality associated with the metabolic syndrome. Diabetes Care.
                                                2001;24:683-689. 

                                             To the Editor: In their study of the metabolic syndrome and
                                                mortality, Dr Lakka and colleagues1 did not assess sleep-disordered
                                                breathing (sleep apnea). Obesity, the central feature of the metabolic
                                                syndrome, is also the greatest risk factor for obstructive sleep apnea
                                                (OSA), which associated with cardiovascular disease in a
                                                dose-dependent way.2-4 The severity of sleep-disordered breathing
                                                also correlates with many other risk factors for cardiovascular
                                                disease, including markers of oxidative stress and of inflammation,
                                                such as adhesion molecules, interleukin 6, and C-reactive protein.5, 6
                                                More convincing, however, is the evidence that treatment of OSA, in
                                                the absence of weight loss or other treatment for metabolic
                                                syndrome, reduces blood pressure7 and cardiovascular risk.4

                                                Barbara Phillips, MD, MSPH, Department of Internal Medicine,
                                                University of Kentucky College of Medicine, Lexington
 

                                                1. Lakka H-M, Laaksonen DE, Lakka TA, et al. The metabolic
                                                syndrome and total and cardiovascular disease mortality in
                                                middle-aged men. JAMA. 2002;288:2709-2716.

                                                2. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered
                                                breathing and cardiovascular disease: cross-sectional results of the
                                                Sleep Heart Health Study. Am J Respir Crit Care Med.
                                                2001;163:19-25. 

                                                3. Mooe T, Franklin KA, Holmstrom K, Rabben T, Wiklund U.
                                                Sleep-disordered breathing and coronary artery disease: long-term
                                                prognosis. Am J Respir Crit Care Med. 2001;164:1910-1914. 

                                                4. Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J. Increased
                                                incidence of cardiovascular disease in middle-aged men with
                                                obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care
                                                Med. 2002;166:159-165. 

                                                5. Dyugovskaya L, Lavie P, Lavie L. Increased adhesion molecules
                                                expression and production of reactive oxygen species in leukocytes
                                                of sleep apnea patients. Am J Respir Crit Care Med.
                                                2002;165:934-939. 

                                                6. Shamsuzzaman ASM, Winnicki M, Lanfranchi P, et al. Elevated
                                                C-reactive protein in patients with obstructive sleep apnea.
                                                Circulation. 2002;105:2462-2464. 

                                                7. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al.
                                                Ambulatory blood pressure after therapeutic and subtherapeutic nasal
                                                continuous positive airway pressure for obstructive sleep apnoea: a
                                                randomised parallel trial. Lancet. 2002;359:204-210. 
 

                                             In Reply: Dr Unwin is concerned that grouping individuals together
                                                under the category of the metabolic syndrome may lead to a loss of
                                                predictive information. We found these individuals not only have a 2-
                                                to 3-fold higher cardiovascular mortality, but also a 5- to 9-fold
                                                increased risk of developing diabetes.1 We hope that future studies
                                                will determine whether the recognition, treatment, and ultimately
                                                prevention of the metabolic syndrome as defined by the NCEP or the
                                                WHO will improve the prognosis of these individuals. Our own clinical
                                                experience suggests that most persons with the metabolic syndrome
                                                but without manifest cardiovascular disease or diabetes go
                                                unrecognized and untreated, because the abnormalities are usually
                                                mild in and of themselves. Focusing on individual or conventional risk
                                                factors only will leave most of these individuals undertreated or
                                                untreated.

                                                Factor analysis has frequently generated different lists of lipid or blood
                                                pressure variables that comprise the metabolic syndrome. The
                                                variables entered into the factor analysis, as well as whether the
                                                rotation permits the factors to be correlated, can also strongly
                                                influence the type of factors generated in addition to the number. For
                                                example, in later analyses we entered apolipoprotein B, uric acid, 
                                                           -glutamyl transferase, and blood pressure medication
                                                in addition to the variables shown in our article and used a promax
                                                rotation that yields correlated factors (unreported observations). In
                                                these analyses, separate lipid and blood pressure factors that also
                                                contained obesity and/or insulin were generated, but the principal
                                                factor, characterized most strongly by adiposity, glucose, and insulin,
                                                also was loaded onto by blood pressure and lipids. All of these
                                                factors loaded onto an underlying metabolic syndrome factor in a
                                                second-order factor analysis. We agree with Unwin that the metabolic
                                                syndrome is a heterogeneous category, like diabetes, impaired
                                                glucose tolerance, cardiovascular disease, and hypertension.
                                                Although possible subcategories of the metabolic syndrome warrant
                                                further study, the WHO and NCEP definitions nonetheless identify
                                                high-risk individuals.

                                                The WHO definition of the metabolic syndrome as originally
                                                published2 used a cutoff of 160/90 mm Hg or higher for blood
                                                pressure. This cutoff was lowered in the final definition (140/90
                                                mm Hg).3

                                                Drs Behre and Fagerberg inquire whether a criterion for insulin
                                                resistance explains why the modified WHO definition was better than
                                                the NCEP definition in predicting cardiovascular mortality. Although
                                                the differences were small, the modified WHO definitions were more
                                                consistently associated with cardiovascular mortality. In our recent
                                                article using diabetes mellitus as an end point for the validation of the
                                                NCEP and WHO criteria, the modified WHO definition was better than
                                                the NCEP definition in predicting diabetes.1 It is likely that at least
                                                with respect to the prediction of diabetes, the difference is in large
                                                part because the NECP definition does not have a measure of insulin
                                                resistance. In that report we also compared the differences in
                                                prevalences of the metabolic syndrome according to those definitions.

                                                Although beyond the scope of our article, we agree with Dr Phillips
                                                that OSA is a major health problem associated with obesity and
                                                overweight, and more specifically with the metabolic syndrome.4 It is
                                                also underdiagnosed. We believe that the presence of overweight or
                                                the metabolic syndrome also should suggest the possibility of OSA.

                                                Hanna-Maaria Lakka, MD, PhD, David E. Laaksonen, MD, PhD, 
                                                MPH, Timo A. Lakka, MD, PhD, Leo K. Niskanen, MD, PhD, 
                                                Esko Kumpusalo, MD, PhD, Jaakko Tuomilehto, MD, PhD,
                                                Jukka T. Salonen, MD, PhD

                                                1. Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT,
                                                Lakka TA. Metabolic syndrome and development of diabetes mellitus:
                                                application and validation of recently suggested definitions of the
                                                metabolic syndrome in a prospective cohort study. Am J Epidemiol.
                                                2002;156:1070-1077. 

                                                2. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of
                                                diabetes mellitus and its complications, I: diagnosis and classification
                                                of diabetes mellitus provisional report of a WHO consultation. Diabet
                                                Med. 1998;15:539-553. 

                                                3. World Health Organization. Definition, Diagnosis, and
                                                Classification of Diabetes Mellitus and its Complications: Report of a
                                                WHO Consultation. Part 1: Diagnosis and Classification of Diabetes
                                                Mellitus. Geneva, Switzerland: World Health Organization; 1999. 

                                                4. Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and
                                                daytime sleepiness and fatigue: relation to visceral obesity, insulin
                                                resistance, and hypercytokinemia. J Clin Endocrinol Metab.
                                                2000;85:1151-1158. 

I was wondering if you could offer a resource for our clientele.  We are a nonprofit wellness center that utilizes fitness, exercise and nutritional counseling to those suffering from disease related wasting.

We are caught in a precarious situation concerning lipodystrophy and nutrition.  Recently two well respected HIV physicians held a nutritional seminar for positive people.  In that lecture, lipodystrophy was discussed and the 'cave man's diet' was recommended by the physicians.  That is, a high protein and low carbohydrate diet, with said sources derived from leafy green vegetables.  Eliminating bread, rice, and grains were suggested.  Yams were allowed, but no other carb dense vegetables.

With all of the conflicting HIV information about increased caloric requirements, changing carbohydrate metabolism, and insulin resistance, we are confounded with such suggestions from this  lecture.  Our clients initially present with very little muscle and an increased abdominal girth.  Skin fold at the abdominal site is usually <8 mm.  Fat percentages are difficult due to the intra-abdominal fat. Our clients who try the Atkin's diet lose muscle mass and body weight, but the abdominal girth remains unchanges.  Those eating a healthy diet close to the ADA food pyramid lose fat and gain muscle.

Our problem lies in the source of the suggested 'cave man diet.'  Our clients need a respected advisor for nutrition.  We would love to locate qualified, experienced dietitians for our clients. Additionally, any literature we could obtain would be great.  We respect your background and are eager to hear your personal advice. Thank you for your consideration.

Sincerely, Director in Texas 

Subject: Re: Fw: lipodystrophy and nutrition
Date: Wed, 23 Apr 2003 11:21:39 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Find information on high protein diets.

The following is edited from this week's HIV Nutrition News Update (Iss. 3, No. 82, April 25, 2003), which has links to a wealth of information:
From a FSIS Press Release- NOTE: Access news releases and other information at the FSIS web site.
AIDSinfo E-News: Offering the latest federally approved information on research, clinical trials, and treatment.

April 11, 2003
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Integrating Nutrition Therapy into Medical Management of HIV

A special supplement to Clinical Infectious Diseases, a journal of The Infectious Diseases Society of America, was published April 1, 2003 (Clinical Infectious Diseases, Volume 36, Supplement 2). It contains a special report on current issues related to nutrition management and HIV infection.

Integrating Nutrition Therapy Into Medical Management Of Human Immunodeficiency Virus is now available.

The supplement is a collaborative work of more than 50 authorities representing a wide range of expertise in conjunction with 5 federal agencies: the Health Resources and Services Administration, the Food and Drug Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, and the Department of Veterans Affairs.

The topics covered in this special include:

*   Assessment of Nutritional Status, Body Composition, and Human Immunodeficiency Virus- Associated Morphologic Changes

*   Weight Loss and Wasting in Patients Infected with Human Immunodeficiency Virus

*   Lipid Abnormalities

*   Body Habitus Changes Related to Lipodystrophy

*   Insulin and Carbohydrate Dysregulation
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The AIDSinfo Help Line has English- and Spanish-speaking Health Information Specialists available Monday - Friday, noon to 5:00 p.m. eastern time. Telephone: 800-448-0440 
International: 301 519-0459    TTY/TDD: 888-480-3739

This is forwarded from the AEGIS electronic listserv:

HIV/AIDS Lipodystrophy: Leptin replacement can ameliorate protease inhibitor-induced lipid abnormalities
AIDSWEEKLY Plus; Monday, October 6, 2003
Staff Medical Writers
-----------------------------------------------------
NewsRx -- Leptin replacement therapy can ameliorate the lipid dysfunction triggered by some anti-HIV drugs.

"A major complication associated with the use of protease inhibitors (PIs) in treatment of HIV- infected patients is lipid abnormalities including dyslipidemia, lipodystrophy, and liver steatosis," researchers in the United States noted. "Previous studies revealed that these abnormalities are associated with PI-induced accumulation of activated sterol regulatory element binding proteins (SREBPs) in the nucleus of liver and adipose tissues, resulting in constitutive activation of lipid metabolism genes."

In their study, T.M. Riddle and colleagues at the University of Cincinnati "used the mouse model to determine the potential of polyunsaturated fatty acid (PUFA) diet or leptin replacement therapy to alleviate these PI-induced metabolic abnormalities."

The "results showed that feeding C57BL/6 mice with a PUFA-rich diet failed to normalize plasma cholesterol and triglyceride levels in ritonavir-treated mice," they reported. "The PUFA-rich diet also had no effect on ritonavir-induced interscapular fat accumulation and liver steatosis."

"In contrast, daily administration of leptin significantly reversed the elevated plasma cholesterol level induced by ritonavir," published data indicated. "Leptin replacement therapy also significantly reduced the ritonavir-induced interscapular fat mass and improved liver steatosis."

"Taken together, these data suggest that PI-induced lipid abnormalities, especially dyslipidemia, lipodystrophy, and liver steatosis, may be reduced with leptin replacement therapy," the researchers concluded.

Riddle and coauthors published their study in the Journal of Acquired Immune Deficiency Syndromes (Leptin replacement therapy but not dietary polyunsaturated fatty acid alleviates HIV protease inhibitor-induced dyslipidemia and lipodystrophy in mice. J Acquir Immune Defic Syndr. 2003 Aug 15;33(5):564-70.

For additional information, contact D.Y. Hui, University of Cincinnati, College of Medicine, Department of Pathology and Laboratory Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267,
USA.

Publisher contact information for the Journal of Acquired Immune Deficiency Syndromes is: Lippincott Williams & Wilkins, 530 Walnut St., Philadelphia, PA 19106-3621, USA.

The information in this article comes under the major subject areas of Adverse Drug Effects, AIDS & HIV, Endocrinology and Lipodystrophy. This article was prepared by AIDS Weekly editors from staff and other reports.

Reference

Riddle TM, Fichtenbaum CJ, Hui DY. "Leptin replacement therapy but not dietary polyunsaturated fatty acid alleviates HIV protease inhibitor-induced dyslipidemia and lipodystrophy in mice", J Acquir Immune Defic Syndr. 2003 Aug 15;33(5):564-70.

Copyright (c) 2003 - Charles Henderson, Publisher. All rights Reserved. Permission to reproduce granted to AEGIS by Charles W. Henderson. Authorization to reproduce for personal use granted
granted by C. W. Henderson, Publisher, provided that the fee of US $4.50 per copy, per page is paid directly to the Copyright Clearance Center, 27 Congress Street, Salem, Massachusetts 01970, USA. Published by Charles Henderson, Publisher. Editorial & Publishing Office: P.O. Box 5528, Atlanta, GA 30307-0528 / Telephone: (800) 633-4931; Subscription Office: P.O. Box 830409, Birmingham, AL 35283-0409 / FAX: (205) 995-1588
Newsrx

AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in
treating HIV.

Copyright (c) 1980, 2003. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content.
 

Hi there, here is a clip from a quick article I wrote for our clinic's HIV newsletter  (snacks and increasing kcal)

How to maximize your snacks:

Get bits of food in when you can.  If you just don’t feel up to sitting down to a great big meal, snack throughout the day.  Have yourself some pudding, toast, piece of fruit, cut veggies, salad, soup, muffin, or half of a sandwich as a snack during the day.

If you are on the run, purchase an economical little cooler for your car or carry non-perishables in your purse, backpack or brief case.   If it is a cooler you choose, you can put any leftover in it!  Carry some spaghetti, sandwiches, leftover meat loaf, cheese and crackers, pudding, apple sauce, fresh vegetables, chicken leg, you name it!  And forget about the Tupperware- just wash and use the plastic containers other  foods come in!

· Peanut butter anything!   Put a dollop of  peanut butter on crackers, whole wheat bread, apples, english muffins (add sliced bananas and honey for extra taste- Elvis’s favorite), celery, carrots, your finger, a spoon, anything!  Peanut butter will provide you with 190 calories and 9 grams of protein in two tablespoons!

· Grab a bar.  Try a sports bar, fruit and oatmeal bar, granola or breakfast bar.  Any kind of "bar" nowadays supplies around 100-150 calories and at least 3 grams of protein.  Those sports bars can provide triple that depending on the kind.

· Nuts and seeds.   Nuts and seeds are easy snacks to keep in your car, your desk, your pocket, cupboard and grocery list.  For example, a quarter cup of mixed nuts provides 203 calories and 8 grams of protein, and who can stop at a ¼ cup?  Remember the rich taste of walnuts, pine nuts, pistachios, roasted peanuts, macadamia nuts,  cashews, almonds, Brazil nuts?  Seeds can also provide a non-perishable snack.  Sunflower seeds  will give you 205 calories and 8 grams of protein.

· Shake things up a bit.  If you have a blender, or rather, if you have a large cup and a fork, you can have a shake.  If dairy is still your friend, stir 8oz. of milk with 1 cup nonfat dry milk to provide 211 calories and 14 grams of protein.  Fruit, juice, chocolate syrup, protein powder, ice cream, frozen yogurt, vanilla extract or ground nuts, to name a few, are excellent additions to a glass of milk (whole, 2%, soy or lactose-free).
Jenna Bell, RD, LD

Sadly, the advice posted to carry food in a cooler in your car is useless to us PWA's who can't afford a car. Running around with enough food to graze all day doesn't leave much room in your backpack for anything else. HAART, in my case, has led to diabetes, high cholesterol, and high blood pressure.

Most prepared foods contain sugar, hydroginated fats and salt. In my case, I require more than 30 pills and capsules a day to   deal with HIV and the side efects of these pills. With recent bp readings of 175 / 111 it has become necessary to take more pills. It is almost impossible to fathom the disstress this causes. Even my antidepressants are depressing me. The only food I feel safe eating is what I cook for myself. Even my dear mother doesn't get it. Salt is still an ingredient in her cuisine. "Only a little, for
taste." 

Essentially I must spend large blocks of time shopping, washing and cooking my own food. I am primarily vegetarian. I do eat fish - usually whole trout, head and tail off, cut in half and baked uncovered for 20 minutes at 350F with a sprinkle of  dill on it. I save the baked head and make a stock with veggies just as one would make a chicken stock. When done, I remove the head and strain the stock. I discard bones and scales; then blend the veggies into the stock. Who needs salt? The flavour is rich and gorgeous. Instead of butter or margarine I mash white lima beans with  olive oil, a little water, herbs and spices; sometimes garlic and crushed almonds.  I even reject mashed potatoes in the hospital cafeteria. I always ask what is in the food. If they use margarine, which they usually do, I reject it. But I can taste the salt in most everything I don't cook myself. In an advanced state of AIDS, GOOD nutrition is extremely important and VERY hard to find! 
Jake

WHERE TO PURSHASE-WHERE INFO BE FOUND. - TOM

You can read about Olive Leaf extract at this web page. Please be sure to read the whole article before you decide to try it. Remember, many herbs can interact with the drugs that the doctor prescribes. Herbs can either decrease or increase the levels of drugs in your body. If you are taking protease inhibitors or antiretrovirals, you should avoid taking any herbs until we can be certain they will not cause potentially dangerous side effects. Olive Leaf extract may be purchased at any health food store. Based on the current (7/8/2000) lack of successful clinical trials, etc, I do not suggest this supplement for any use.
Sharon Ann Meyer

Does anyone have information on the origin of HIV?

Re: Subject: HIV origin
Date: Tue, 22 Aug 2000 08:50:51 -0700 (PDT)
From: Sharon Ann Meyer 

Please review the information at: NIAID/NIH Focus on HIV

If you don't have a web browser write me back and I'll paste the information into the email.

Author Addition: There is also a slide show that deals a bit with this topic.

A very useful book, "EveryBody Preventing HIV and Other Sexually Transmitted Diseases Among Young Teens" is a powerful,  research-based curriculum for 5th - 9th grade students about HIV, AIDS and sexually transmitted disease (STD)prevention. For more information visit the Prevent Aids Web Site. Deborah Schoeberlein

I need info on relief for symptoms of menopause, yet I am not menopausal. It's not night sweats, it's profuse sweating all day long. BC Pills did not help. I am on a med vacation now but this has been going on since 6/99 after delivery of new baby girl. Please help. Lisa Marie

Hi Lisa Marie,
You said, "I need info on relief for symptoms of menopause...

I am wondering if perhaps some of the sweating may be a drug side effect. Even though you're on a drug holiday you may still be taking non-HIV drugs that could cause this. I know that some drugs such as nortriptyline (Pamelor- an antidepressant) can cause sweating. You can search the RxList site to search for information on the medications you currently take. Just entering the word sweating displays close to 300 drugs!

If you are between the ages of 38 to 52 it is possible that you are experiencing some symptoms of menopause. Some women reach menopause earlier than others and can experience profuse sweating, increased heart rates, insomnia and other symptoms. I experienced profuse sweating especially when I slept for two years before the doctor finally admitted that it might be hormone related.

My first concern is that you drink enough fluids throughout the day to stay hydrated. Try to wear light cotton clothing and stay where it's cooler. I have used anti-perspirant -&- deodorant along with baby powder with some success in limiting the amount of sweat under my arms. If you haven't discussed this with your doctor, please make an appointment so you can discuss your concerns.

I have emailed a few of my colleagues to see if perhaps they might have some advice that may help. If I get back anything from them I'll let you know. In the meantime, you might want to try a few web sites to see if you can find more information on your concern. 

Try the government web sit 4 Women web site
Also, try visiting the Womens Health web site
Sharon Ann Meyer

I am attaching the menopause file that I have accumulated- Since she is not on any meds nothing there should be harmful- Most often though when people have night sweats it's a sign of something big- I have not worked with pregnancy and lactation - it may go along with that territory.

Be sure to discuss all possible treatments with your doctor because some supplements can and do affect prescribed medications. I hope you find this information helpful and that it helps to lessen your problem.

MENOPAUSE

Menopause, speaking biologically, is the moment of woman's final menstrual period. Menopause occurs when a woman's ovaries run out  of eggs marking the end of her reproductive years. The average age for menopause in the U.S. is 51. 

But when most people speak of menopause they are probably referring to the "symptoms" that occur. They include hot flashes that can occur as early as age 30.  They are described as "red-in-the face, sweaty moments" that are caused by a drop in estrogen. 

Night sweats and sleep disruption is often part of the syndrome. Some natural remedies are listed below. Hormone replacement therapy is an option if you and your doctor agree that it is safe for you.

Herbal remedies

Black Cohosh (approved in Europe for treatment)- Chills and hot flashes, depression and vaginal dryness.

Why hot flashes?  One theory that during menopause estrogen decreases and a chemical called lutenizing hormone rises possibly affecting the body's thermostat. Hot flashes may be trying to regulate the body's temperature. Flash and you fan your face!

Rx: Black cohosh lowers the level of lutenizing hormone 40 mgs/day Side effects: wt gain upset stomach, headache dizziness in some studies.

Soybeans- estrogen -like isoflavones.  Asian women have fewer hot flashes than Americans do. Soy also lowers cholesterol. May lower  the risk of breast, colon, endometrial cancers, osteoporosis and strokes. One study showed that 34 mgs found in soy powder reduced the severity but not frequency of hot flashes.

Caution: Breast cancer studies are still in infancy. At risk women are advised to eat no more than one serving of soy/day until more is learned. See Breast Cancer and diet also on the Always Your Choice web site.

Valerian- Sleep difficulties, anxiety and depression associated with menopause.

Helps to develop better sleep patterns after regular use for several weeks- 2-3 gms/day. Tea= 1 tsp. dried herb, tincture or extract to one cup hot water. In lower does ½ tsp. useful as mild tranquilizer St John's Wort (hypercin) to treat moderate depression. 300mg standardized extract 3Xday.

Kava- anxiety - it promotes relaxation and is non-addictive or habit forming.  60-120mgs of kavapyrones/day. Don't use kava in combination with alcohol, barbiturates or other agents that can depress the central nervous system. 

Sage to eliminate night sweats- 4 Tbsp. dried sage in 1-cup hot water. Cover tightly and steep 4 hours or more. Strain -&- drink.

Red Clover- estrogen like properties that inhibits estrogen based cancers by blocking carcinogenic forms of estrogen and eases menopausal symptoms in women. 

Donna Tinnerello - May 2000