I am trying to find more information on the Ross nutritional product Advera.  I mainly wanted to know if people with HIV liked this product, tolerated it well, and also if there are any real benefits to using this versus boost or ensure plus. 
Joyce Diller 
 

Subject: Re: Advera
Date: Fri, 06 Sep 2002 14:43:58 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

You'll find product information for Advera at the Abbott Web Site, although web page addresses change, you may find more information on this product as I did at Google.

I found that Advera is better than most other supplements for people with diarrhea. Most people said it was not as overly sweet as some of the other nutritional supplements. 

Subject: Re: Advera
Date: Sat, 07 Sep 2002 13:13:09 -0400
From: HIV Nutrition Discussion List 

Most people can make their own supplements with little cost by using the foods they already have at home or that they get at food banks.  They can mix together some low-fat or skim milk, their favoritve extract such as vanilla, some banana or other fruit, and honey or a sugar substitute with ice. I like the thought of consuming whole foods instead of costly supplements that are full of synthetics. 
Donna

My husband will have a hip replacement because of avascular necrosis.  The orthopedic surgeon assured him it had nothing to do with his AIDS but I went looking for more info anyway.  I found in Project Inform September 2000 that necrosis is slowly beginning to appear in long-term survivors but they don't know whether it s the disease itself or the medications causing the bone death.  It's supposed to be a rare complication.  I'm disturbed by the fact that I found within 10 minutes of computer search a 2-year-old article saying the opposite of the orthopedic surgeon.  He did say the problem is just appearing in his other hip, and I'm afraid if steps aren't taken to stop it, it will have to be replaced also with the extra strain being put on it by his being on a cane and then the long-term recovery afterwards.  He is a top-knotch hip replacement surgeon so we probably will have him do the surgery.  But for the future we need either a more up-to-date doctor or we have to get him up-to-date ourselves. 

Is there more up-to-date information on bone problems in AIDS patients and orthopedics who specialize in AIDS patients bone problems? 
Jenny 

Subject: Re: Avascular necrosis
Date: Mon, 02 Sep 2002 09:38:29 -0400
From: HIV Nutrition Discussion List

I first heard of this problem in the year 2000. We did an interview with Dr. Mary Romeyn in Issue 26 of the HIV ReSource Review. One paragraph follows: 

DT: What is avascular necrosis (AVN)? Is this the osteoporosis we are witnessing or is there something more? 

MR: Osteoporosis is a loss of supportive material from the bone, making it frail because of reduced mineral content. When present to a lesser degree it is called osteopenia.  Osteonecrosis is death of bone. When it occurs as a result of vascular trauma or insufficiency, it’s called avascular necrosis. Possible direct causes may be fat emboli, other intravascular events disturbing blood flow, or trauma. While sometimes we don’t know what causes it, we see it more frequently where glucocorticoids
such as prednisone are used. (1) In people with HIV, we see it without glucocorticoid use as well. It may be more common in the setting of protease inhibitors(2), and has also been found in association with megestrol acetate(3); although this may represent an effect of wasting rather than its treatment. 

There are also a number of references to this issue in the free weekly HIV Nutrition Update archives .  You can also use the HIV ReSources Search Engines Page at to look for more information on 
avascular necrosis. 

Also, visit links to help you find a more knowledgeable doctor. If you can't see an HIV-specialist, take all the information you can get and educate this doctor. 
Sharon Ann Meyer
 

My husband also had a hip replacement because of bone death and in my research I found that this is beginning to be found in long-term survivors and thought to be a side-effect of the cocktail.  His doctors were unaware too but eagerly took the printouts I made.  His other hip is beginning to be affected and if there is a possible treatment we're eager to know.  He seems to be developing the body build of someone with  lipodystrophy too.  Thanks for all the help you've given us in the past.

Subject: Re: Hip replacement
Date: Tue, 08 Apr 2003 13:59:32 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

For more information on bone health and especially in those with HIV try visiting these web sites:
AIDSinfo
MEDLINEplus
Medscape
National Osteoporosis Foundation
Office of AIDS Research at NIH
Project Inform
PubMed
PWA Health Group
The Body

All the best.

Does anyone have information on osteoporosis? What it is and what to do if you have it? Thanks.
Lisa Marie

Subject: Re: Osteoporosis
Date: Fri, 09 Mar 2001 18:01:20 -0500
From: HIV Nutrition Discussion List - Sharon Ann Meyer

As a disclaimer, I have no affiliation with the following newsletter, web site or authors and am just passing this information on as it came to me, with updated web site links. Here is a newsletter with some articles on osteoporosis to compliment information published in the HIV ReSource Review:

=============Electronic Edition=========
DATE: March 7, 2001, Volume 11, Number 13

THIS WEEK'S STORIES

- HIGH BONE DENSITY DOESN'T ALWAYS PROTECT WOMEN FROM FRACTURES

- LOW ESTRADIOL, HIGH BONE TURNOVER MAY SPUR OSTEOPOROSIS IN MEN

- WEIGHT/BONE LOSS, GLUCOSE, AND OSTEOPOROSIS RISK

QUOTE OF THE WEEK
"Genetics may load the gun, but environment pulls the trigger." Pamela Peeke, M.D., M.P.H., Fight Fat After Forty (2000). Read about the author and her new book online at our website
==============

Great Smokies Connection is a complimentary E-mail newsletter provided by Great Smokies Diagnostic Laboratory. Each week we bring you reports of recent clinical developments related to functional and integrative medicine. We hope that you find our reports interesting, but before you consider using any of the research findings in your practice, please conduct your own investigation to delineate the possibly conflicting evaluations of the conclusions. And please read the NOTICE following this week's reports, which explains more fully the educational nature of this publication.

To enter subscriptions for friends and colleagues--or to change your own subscription status-- see the section SUBSCRIBE/UNSUBSCRIBE INFORMATION, following news stories.
==============
- HIGH BONE DENSITY DOESN'T ALWAYS PROTECT WOMEN FROM FRACTURES
==============
- RESEARCHERS REPORT INCREASED FRACTURES IN WOMEN WITH TYPE-2 DIABETES

Sometimes you have to look deeper to get the whole truth. When it comes to osteoporosis, it's not just how dense an older woman's bones are, but how they're built and broken down, that may determine her actual risk of an osteoporotic fracture. And, surprisingly, blood sugar control may also play an important role - by influencing how often she falls.

The Study for Osteoporotic Fractures (SOF), one of the largest prospective cohort studies of osteoporosis and bone fracture risk ever conducted, examined over 9700 community-dwelling American white women over age 65 at baseline and then tracked their rates of osteoporotic fracture over a 9-year period.

The study's investigators found that women with type-2 diabetes had a 22% greater likelihood of suffering a non-spinal fracture, despite having higher bone mass density than women without diabetes. Type-2 diabetic women not using insulin had 82% more hip fractures and nearly twice as many arm fractures (proximal humerus) as their non-diabetic counterparts. A significantly higher risk of fractures of the arm, ankle, and foot were also found in type-2 diabetic women not using insulin, compared to their healthy peers.

On the surface, the results seemed surprising. Obesity and increased bone density, both commonly associated with type-2 diabetes, normally reduce a woman's risk of suffering an osteoporotic fracture. So why did the type-2 diabetic women have more fractures?

Researchers theorized that complications associated with type-2 diabetes, such as retinopathy which impairs vision, may increase the number of falls and make fractures more likely. Surprisingly, poor
blood sugar control may also play a role. "Variations in glycemic control may also be relevant to falls because acute fluctuations in glucose levels can transiently affect visual and nerve function, as well as cognition,"  observed Dr. Dorothy A. Nelson and Dr. Scott J. Jacober of Wayne State University School of Medicine in a related editorial.

In addition, bone density alone can be misleading. The doctors pointed out that bone density does not provide a full indication of a woman's risk of osteoporotic fracture, since it does not assess bone
structural strength or architecture. Thus it may miss an important piece of the puzzle, especially in women with diabetes. Researchers speculate that diabetes, by reducing blood flow to the lower
extremities, interferes with the bone remodeling process, causing accelerated bone turnover.

They cautioned practitioners to remember that "osteoporotic fractures result not just from a low bone mass but from decreased bone quality and an increase in injurious falls."

NOTE: Bone turnover markers on the Bone Resorption Assessment can provide an important indication of the strength of a patient's bone architecture, making them critical components for accurately assessing risk of osteoporosis and fracture, in addition to a bone density scan. 

For a recent discussion of the advantages of bone resorption testing, read: Wilkin TJ. Changing perceptions in osteoporosis. BMJ 1999:318:862-65. Full text online. In an October 1998 Symposium feature, "Biochemical markers of bone turnover: A look at laboratory tests that reflect bone status" (Postgraduate Medicine 1998;104[4]), Clifford J. Rosen, M.D.; and Alan Tenenhouse, M.D., rated ELISA of free deoxypyridinoline as highly or more highly than the other bone resorption tests examined - higher in ease of use and bone specificity; lower in variability. You can read the article
online at http://www.postgradmed.com.

The Metabolic Dysglycemia Profile alerts to early signs of glycemic and hormonal dysregulation that can lead to the myriad complications associated with type-2 diabetes, including retinopathy, neuropathy, dementia, vascular disease, and osteoporotic fracture. Effective prevention depends on early identification of imbalances and consistent monitoring of treatment to ensure optimal glycemic
function. 

Sources:
> Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, Tabor HK, Schreiner PJ, Jamal SA, Black DM, Cummings SR. Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 2001;86:32-38.

> Nelson DA, Jacober SJ. Why do older women with diabetes have an increased fracture risk? [Editorial] J Clin Endocrinol Metab 2001;86:29-30.

==============
- LOW ESTRADIOL, HIGH BONE TURNOVER MAY SPUR OSTEOPOROSIS IN MEN
==============

- BIOAVAILABLE STEROID LEVELS DECLINE DURING AGING PROCESS

Whether or not you believe that men come from Mars and women from Venus, they have one important thing in common: both seem to depend on adequate levels of estrogen to maintain the structural strength of their bones as they age.

To better understand the relationship between sex hormones and osteoporosis in men, French researchers recently measured serum steroid levels and bone turnover markers in a cohort of 596
middle-aged and older males between the ages of 51 and 85, as part of the MINOS prospective study on osteoporosis.

Their major discovery was that men's bone health, like women's, appears to depend heavily on their levels of estrogen. The men with the lowest levels of bioavailable 17-beta-estradiol, the body's most
potent estrogen, also had the highest rates of bone loss, as measured by deoxypyridinium, a collagen crosslink excreted in urine.

"Our results also suggest that 17-beta-estradiol is the most potent determinant of BMD [bone mineral density] among sexual steroids in men." They estimated that men with the lowest 17-beta-estradiol levels had 50-100% increased risk of a fracture, compared to those with the highest levels. Having both high bone turnover and low 17-beta-estradiol appeared to trigger the most drastic drops in bone density - about 8% and 10% lower at the hip and distal forearm, respectively.

The study also suggested that biologically active steroid hormones exert the strongest effect on bone mass. Importantly, only bioavailable levels of 17-beta-estradiol, as well as bioavailable levels of testosterone, decreased in the men as they aged. The total levels of these two steroid hormones, which  include hormone bound inertly to carrier proteins, remained unchanged and thus did not as clearly reflect the degenerative aging process.

NOTE: Bioavailable 17-beta-estradiol, a standard marker on the Female Hormone Profile and the Menopause Profile, is also available as an add-on marker for the Male Hormone Profile. These assessments utilize salivary analysis, which measures only bioactive steroid levels and allows convenient, multiple sampling to evaluate diurnal rhythms.

The Bone Resorption Assessment measures the urinary excretion of collagen crosslinks deoxypyridinium and pyridinium referenced to creatinine and provides a powerful, yet non-invasive method for detecting rapid bone turnover. This test is an important tool for monitoring clinical response to bone-building therapies in men and women of all ages.

You can read the National Osteoporosis Foundation's feature on men and osteoporosis and reports on the subject from our archives.

Source: Szulc P, Munoz F, Claustrat P, Garnero P, Marchand F, Duboeuf, Delmas PJ. Bioavailable estradiol may be an important determinant of osteoporosis in men: the MINOS study. J Clin
Endocrinol Metab 2001;86:192-199.

==============
- WEIGHT/BONE LOSS, GLUCOSE, AND OSTEOPOROSIS RISK

Lab Tidbit

Two recent studies shed a little more light on the weight/diabetes/osteoporosis relationship in women. One of the few positive aspects of being overweight after menopause is the apparent association between higher body mass and lower risk for osteoporosis - except, as the Study for Osteoporotic Fractures data indicated, in women with diabetes.

Osteoporosis and fracture risk, according to a study presented at last fall's Annual Meeting of the American Society of Bone and Mineral Research, may have their roots in patterns of bone formation
and loss decades before problems develop. Researchers used urinary pyridinium crosslinks to determine that the obese and overweight postmenopausal women they tested did not evidence a significantly lower rate of resorption, despite their greater bone mineral density and content. Instead, they may have achieved a higher peak bone density in their twenties and thirties than lower weight women in the study did.

And although conditions resulting from diabetes may play a role in fracture, dysglycemia itself can gradually weaken bone structure by its actions at the cellular level. Researchers from Northwestern
University cultured murine cells in a high glucose concentration and found that the medium stimulated cellular proliferation while inhibiting calcium uptake. "Bone could be structurally altered in diabetes," they concluded - possibly helping to explain why weight is not protective against osteoporosis in postmenopausal diabetic women.

Nutritional support indicated and monitored by Bone Resorption Assessment initiated during a woman's 30s and 40s offers healthcare providers an opportunity to help reduce the risk for osteoporosis and fracture later by lowering the rate bone is lost. Early identification and intervention based on results of the Metabolic Dysglycemia Profile can help women maintain a steady rate of bone
formation, lowering the risk for glucose-impaired bone structure.

Sources:

> Cifuentes M, Johnson M, Lewis RD, Modlesky C, Shapses SA. Body weight reflects bone resorption in lean, but not overweight or obese postmenopausal women [presentation number M321]. 22nd Annual Meeting of the American Society of Bone and Mineral Research, Toronto,Canada - September 22 - 26, 2000.

> Balint E, Szabo P, Marshall CF, Sprague SM. Glucose-induced inhibition of in vitro bone mineralization. Bone 2001;28(1):21-28.

###################################################
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Researched, written, and edited by Eddy Ball, Editor, Patrick Runkel, Associate Editor, and Scott Holmes, Contributing Medical Writer.

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Internet
 

Subject: Bone problems
Date: Sat, 31 Aug 2002 21:28:12 EDT
From: HIV Nutrition Discussion List 

Hi 
I really appreciate the information that you send.  My husband was diagnosed a little over 2 years ago with AIDS.  He must have been given tainted blood in his surgery for prostate cancer ten years ago because even though we had not known for 8 years I was negative and still am.

My husband will have a hip replacement because of avascular necrosis.  The orthopedic surgeon assured him it had nothing to do with his AIDS but I went looking for more info anyway.  I found in Project Inform September 2000 that necrosis is slowly beginning to appear in long-term survivors but they don't know whether it s the disease itself or the medications causing the bone death.  It's supposed to be a rare complication but of course it's the rare problems that come up with him.  He has an appointment with his HIV doctor, just a usual checkup, since he was told the hip problem had nothing to do with AIDS and didn't make an appointment for an earlier date.  He's taking the printout of what I had found.  I'm disturbed by the fact that I found within 10 minutes of computer search a 2-year-old article saying the opposite of the orthopedic surgeon.  He did say the problem is just appearing in his other hip, and I'm afraid if steps aren't taken to stop it, it will have to be replaced also with the extra strain being put on it by his being on a cane and then the long-term recovery afterwards.  He is a excellent hip replacement surgeon so we probably will have him do the surgery.  But for the future we need either a more up-today orthopedic or if we have to get him up-to-date ourselves. 

Could you see if there is more up-to-date information on bone problems in AIDS patients and if there are orthopedics who specialize in AIDS patients bone problems.  Normally the hips are the first to go because of all the weight put on them, then the knees, maybe next shoulders.  This is the first AIDS problem to appear since the pneumonia when he was diagnosed.  If there is anything he can do to slow it down or prevent it, he will do it.  In the meantime he is in a lot of pain needing daily pain meds and has to have a cane to get around in.  He had bought a canoe for weekend outings and right now he can't do any heavy lifting.  He is going to the place that sold him the canoe and renting one that's already in the water to keep up his arm strength for later.  But this has definitely caused a setback in his feelings of beating this beast. 

Thank you for any info you can get or at least where to go for it.
 

Subject: Re: Bone problems
Date: Sun, 01 Sep 2002 13:31:38 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Hi, 
Good to hear from you. I first heard of this problem in 2000. We did an interview with Dr. Mary Romeyn in Issue 26 of HIV ReSource Review. One paragraph follows: 

DT: What is avascular necrosis (AVN)? Is this the osteoporosis we are witnessing or is there something more? 

MR: Osteoporosis is a loss of supportive material from the bone, making it frail because of reduced mineral content. When present to a lesser degree it is called osteopenia.  Osteonecrosis is death of bone. When it occurs as a result of vascular trauma or insufficiency, it’s called avascular necrosis. Possible direct causes may be fat emboli, other intravascular events disturbing blood flow, or trauma. While sometimes we don’t know what causes it, we see it more frequently where glucocorticoids such as prednisone are used. (1) In people with HIV, we see it without glucocorticoid use as well. It may be more common in the setting of protease inhibitors(2), and has also been found in association with megestrol acetate(3); although this may represent an effect of wasting rather than its treatment. 

There are also a number of references to this issue in the free weekly HIV Nutrition Update. Archives are at our web site. 

Resources links may be helpful for you to visit. If you can't see an HIV-specialist, take all the information you can get and educate this doctor. Good luck and feel free to write again. 

I work with a woman that was put on fosamax and calcium. She has walked daily. She had a bone scan last week and the results were worse. She has lost bone mass and worried as her doctor is prescribing a higher dose of fosamax with more calcium. I need guidance on treatments for osteopenia and their effects on nutrition.
 

Subject: Re: Bone Drugs
Date: Wed, 25 Sep 2002 13:38:36 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

With anti-osteoporosis drugs it is vital to make sure patients take them as directed. Zaneta M. Pronsky, MS, RD, FADA author of Food Medication Interactions and Sister Jeanne P. Crowe, PharmD, RPh authored the feature article in the Sept/Oct HIV Nutrition Update. In it they note: 
"...significant reduction in drug absorption is the anti-osteoporosis drugs alendronate (Fosamax) or risedronate (Actonel). Absorption is negligible if these drugs are given with food and reduced by 60% if taken with coffee or orange juice. The manufacturer’s instructions are to take the drug on an
empty stomach at least 30 minutes before breakfast. However, in one study bioavailability was reduced 40% when 10 mg of alendronate was taken 30-60 minutes before breakfast as compared to 2 hours before." 
--

Also, more than just calcium is needed to build bone. Along with vitamin D, ipriflavone, a synthetic flavonoid (isoflavone) is derived from the soy compound daidzein. Ipriflavone promotes the incorporation of calciium into the human bodny and lessens bone breadkdown. Visit the Always Your Choice web site to see a dietitian's article on what specific nutrients may be helpful.

My husband now has osteoarthritis along with the HIV. Where can I find more information on it and are their any food considerations? Thank you in advance.
 

Subject: Re: Osteoarthritis
Date: Thu, 25 Apr 2003 16:37:22 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

See the MEDLINEplus subject on osteoarthritis. Also, there is some information on the unusual use of leeches to treat osteoarthritis. This article is available in the journal from the American College of Physicians. Also check out the information here on Glucosamine.

Does anyone have some good web sites bookmarked that they go to for information on osteoporosis and protease inhibitors? Is it really common to get bone disorders from PIs? Thanks in advance.
Michelle Desmond
 

Subject: [Hivnutritiondiscussionlist] PIs & Osteoporosis
Date: Tues, 14 Oct 2003 00:36:01 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Find more information on this topic at AIDSMeds.

How much protein and calories does a person with HIV positive need while they are still fairly healthy?  This person is a woman 5'5" and wt 145 (was dx 10 yrs ago).  Would the protein level be 1.2-1.5g/kg or higher?  Should she eat to maintain her wt or try to gain wt?
Thanks for your assistance!
 

Subject: Re: HIV calorie & protein needs?
Date: Fri, 27 Jul 2001 11:41:09 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Irene,
There are many considerations to be made before recommending calorie and protein levels for people living with HIV. If the person has been HIV-positive for over ten years it is likely that her calories needs are increased even without secondary infection. Along with gender, body size, age and nutritional status, some of the things to consider are thyroid function and stress/infection factors. Protein needs should also consider nitrogen losses, infection and physical exercise. For those with adequate protein stores 1.2gm/kg should be sufficient. Also, when making dietary recommendations, if she is on a protease inhibitor combination, you need to be watchful for signs of heart disease, glucose intolerance, and bone disorders.

Please consider joining the HIV/AIDS DPG if you make suggestions/recommendations to HIV+ people. Their list serv is used by members for questions like these. Also, numerous clinicians who work with HIV+ people subscribe to the newsletter published by HIV ReSources. If you are interested in literature reviews on calories, protein and other needs that HIV+ people have consider the HIV ReSource Review newsletter.

Can you give a range of calories and protein needed for men and women? Thanks. 
Sara 
 

Subject: Calorie & Protein Needs
Date: Sun, 25 Aug 2002 18:08:05 -0400
From: HIV Nutrition Discussion List

 For HIV-positive people without symptoms who are at their desirable weight, 16-18 calories per pound (lb) for men and 13-15 calories per lb for women should be enough. Protein needs vary but again if you're healthy a range of .45 to .68 grams (gm) of protein per lb of body weight is suggested. One gm for every two lbs you weigh (½ gm/lb) is easier to calculate. 
 

Subject: Calorie needs
Date:  Tue, 01 Apr 2003 13:49:52 -0500
From: HIV Nutrition Discussion List

How many calories does a person with HIV need while they are still fairly healthy?  This person is a woman 5'5" and weighs 125.  Should she eat to maintain weight or try to gain weight? 
Diane Riddler - New Mexico 
 

Subject: Re: Calorie needs
Date: Wed, 02 Apr 2003 15:45:38 -0500
From: HIV Nutrition Discussion List - Sharon Ann Meyer

We noted some information on this herb in an earlier message. Check the Main Archive Page for a list of topics already discussed on the list.

There are many considerations to be made before recommending calorie levels for people living with HIV. If the person has been HIV-positive for many years it is likely that calorie needs are increased even without secondary infection. Along with gender, body size, age and nutritional status, some of the things to consider are thyroid function and  stress/infection factors. A minimum daily intake of 16 calories for each pound of baseline weight before infection or wasting for men and between 13-14 calories for each pound of body weight for women is a reasonable starting point. 

Please consider joining the HIV/AIDS DPG if you make suggestions/recommendations to HIV+ people. Their list serv is used by members for questions like these. Also, numerous clinicians who work with HIV+ people subscribe to the newsletter published by HIV ReSources. If you are interested in literature reviews on calories, protein and other needs that HIV+ people have consider the HIV ReSource Review newsletter. 
 

Subject: Re: Calorie needs
Date: Wed, 26 Mar 2003 18:19:57 -0500
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Recently the EJCN (European Journal of Clinical Nutrition) published an article, "Calculating energy requirements for men with HIV/AIDS in the era of highly active antiretroviral therapy". The lead author is Marijka J Batterham in Australia. Here's the abstract:

Objectives: 1. To determine if resting energy expenditure (REE) adjusted for body composition is elevated in HIV positive males when compared with healthy controls in the era of highly active antiretroviral therapy.

2. To examine the accuracy of prediction equations for estimating REE in people with HIV. 

3. To determine if REE adjusting for body composition is significantly different between those HIV positive subjects reporting lipodystrophy (LD) or weight loss and those who are weight stable when compared to controls.

Design: cross sectional study

Setting: Tertiary referral hospital HIV unit and an outpatient clinic specialising in HIV care.

Subjects: HIV positive males (n=70) and healthy male controls (n=16).

Methods: REE was measured using indirect calorimetry. Body composition was assessed using bioelectrical impedance analysis.

Results: 1. REE when adjusted for fat free mass and fat mass using the general linear model (analysis of covariance) was greater in HIV positive subjects than controls (7258?810kJ n=70 Vs 6615?695kJ n=16, P<0.05). 

2. The Harris and Benedict, Schofield, Cunningham and the two equations previously published by Melchior and colleagues in HIV positive subjects all gave an estimate of REE significantly different from the measured REE in the HIV positive subjects, therefore a new prediction equation was developed. The inability of the published equations to predict REE in the different HIV positive subgroups reflected the heterogeneity in body composition.

3. REE adjusted for fat free and fat mass was significantly greater in the both the HIV patients who were weight stable and those with lipodystrophy compared to the healthy controls.

Conclusion: REE is significantly higher in HIV positive males when compared with healthy controls. Body composition abnormalities common in HIV render the use of standard prediction equations for estimating REE invalid. When measuring REE in HIV positive males adjustment steps should include fat free and fat mass. 

So, in my humble opinion, it is especially important to see a dietitian who specializes in HIV. If you live in the U.S., visit the ANSA web site for organizations that employ such nutrition professionals.
 

Does anyone know anything about bovine colostrum? I heard it might be helpful in treating intestinal illnesses. Thanks 
Linda St. James

Subject: Re: Colostrum
Date: Thu, 19 Sep 2002 13:47:03 -0400
From: HIV Nutrition Discussion List

We covered this topic in our Q&A Nutrition Forum column of the HIV Nutrition Update newszine issue dated Sept/Oct 2001. 

"Preliminary research on bovine colostrum (completed mainly outside of the U.S. and using very small study groups), shows that it may increase bone-free lean body mass in active men and women (4), prevent non-steroidal anti-inflammatory drug-induced gastrointestinal damage (5), improve the outcome of Alzheimer's disease in patients with mild to moderate dementia (6), and lessen stool output and the frequency of loose stools in people with enteric infections. (7-12) Although early studies noted it may be effective against Cryptosporidium parvum and suggested placebo-controlled trials (13-16), documentation of subsequent clinical trials are lacking." Our references were: 

1. Korhonen H, Marnila P, Gill HS. Bovine Milk Antibodies For Health. Br J Nutr, 2000;84(Suppl 1):S135-46. 

2. Korhonen H, Marnila P, Gill HS. Milk Immunoglobulins And Complement Factors. Br J Nutr 2000; 84(Suppl 1):S75-80. 

3. Korhonen H. Immune Milk Preparations - Novel Means For Prevention And Treatment Of Human Microbial Diseases. Jokioinen, Finland: Agricultural Research Centre Of Finland, Food Research; September 2000. 

4. Antonio J, Sanders MS, Van Gammeren D. The effects of bovine colostrum supplementation on body composition and exercise performance in active men and women. Nutrition 2001;17(3):243-247. 

5. Playford RJ, MacDonald CE, Calnan DP, Floyd DN, et al. Co-administration of the health food supplement, bovine colostrum, reduces the acute non-steroidal anti-inflammatory drug-induced increase in intestinal permeability. Clin Sci (Lond) 2001;100(6):627-33. 

6. Leszek J, Inglot AD, Janusz M, Lisowski J, et al. Colostrinin: a proline-rich polypeptide (PRP) complex isolated from bovine colostrum for treatment of Alzheimer's disease. A double-blind, placebo-controlled study. Arch Immunol Ther Exp (Warsz) 1999;47(6):377-85. 

7. Huppertz HI, Rutkowski S, Busch DH, Eisebit R, et al. Bovine colostrum ameliorates diarrhea in infection with diarrheagenic Escherichia coli ,shiga toxin-producing E. Coli, and E. coli expressing intimin and hemolysin. J Pediatr Gastroenterol Nutr 1999;29(4):452-6. 

8. Sarker SA, Casswall TH, Mahalanabis D, Alam NH, et al. Successful treatment of rotavirus diarrhea in children with immunoglobulin from immunized bovine colostrum. Pediatr Infect Dis J 1998;17(12):1149-54. 

9. Ebina T. Prophylaxis of rotavirus gastroenteritis using immunoglobulin. Arch Virol Suppl 1996;12:217-23. 

10. Mitra AK, Mahalanabis D, Ashraf H, Unicomb L, et al. Hyperimmune cow colostrum reduces diarrhoea due to rotavirus: a double-blind, controlled clinical trial. Acta Paediatr 1995;84(9):996-1001. 

11. Tacket CO, Binion SB, Bostwick E, Losonsky G, et al. Efficacy of bovine milk immunoglobulin concentrate in preventing illness after Shigella flexneri challenge. Am J Trop Med Hyg 1992;47(3):276-83. 

12. Tacket CO, Losonsky G, Link H, Hoang Y, et al. Protection by milk immunoglobulin concentrate against oral challenge with enterotoxigenic Escherichia coli. N Eng J Med 1988;318(19):1240-3. 

13. Greenberg PD, Cello JP. Treatment of severe diarrhea caused by Cryptosporidium parvum with oral bovine immunoglobulin concentrate in patients with AIDS. J Acquir Immune Defic Syndr Hum Retrovirol 1996;13(4):348-54. 

14. Plettenberg A, Stoehr A, Stellbrink HJ, Albrecht H, Meigel W. A preparation from bovine colostrum in the treatment of HIV-positive patients with chronic diarrhea. Clin Investig 1993;71(1):42-5. 

15. Rump JA, Arndt R, Arnold A, Bendick C, et al. Treatment of diarrhoea in human immunodeficiency virus-infected patients with immunoglobulins from bovine colostrum. Clin Investig 1992;70(7):588-94. 

16. Nord J, Ma P, DiJohn D, Tzipori S, Tacket CO. Treatment with bovine hyperimmune colostrum of cryptosporidial diarrhea in AIDS patients. AIDS 1990;4(6):581-4. 
Sharon Ann Meyer
 

Dear Sir/Madame
I am a research student (PhD) at the dep't of biochemitry in the University of Yaounde-cameroon.
Its with much interest that I read your abstracts communicated through the electronic media.These include those on knowledge retention of people with HIV/AIDS After review of basic nutrition
Handouts;and that on Nuritional care guides (by fenton M and meyer SA).

We made some related studies in this fieldand hope to carryout more studies. I have got alot of questions and ideas (in the domain of nutrition and AIDS) that can help me in my career. Should you be disposed  our subsequent correspondences will surface these. For now I inquire on the dates of any
conferences and training workshops.When is the date of the next ANSA meal Conference
Sincerely Forkah

Subject: Re: Interesting abstracts & Conference Information
Date: Thu, 25 Apr 2002 16:30:18 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Thanks for your message. Conference information for ANSA is on their web site.

Good luck in your studies.

Can someone offer places to learn more about HIV and nutrition?

Subject: Re: Conferences
Date: Wed, 17 Apr 2002 08:30:30 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

A variety of information on conferences related to nutrition and HIV is at:
HIV/AIDS DPG Web Site
HIV ReSources Conference Page
 

Can anyone tell me if vanadium supplements would be good for diabetes? Thanks
Carol

Subject: Re: vanadium and diabetes
Date: Mon, 17 Sep 2001 16:10:59 -0400
From: HIV Nutrition Discussion List

As noted in the Jan/Feb 2001 (Issue 28 in PDF format) of the HIV ReSource Review, "Although vanadium supplementation in diabetes increased diabetic control in Type 2 diabetics, there is an inconsistent response among patients. Furthermore, pharmaceutical doses of 25-50 mgs per day are needed and vanadium is toxic at more than 10 mg per day. Vanadium adverse effects include
gastrointestinal intolerance and decreased HDL cholesterol. " The reference is from the U.S. Office of Dietary Supplements.
Sharon Ann Meyer

Subject: Re: vanadium and diabetes
Date: Wed, 19 Sep 2001 15:31:00 -0400
From: HIV Nutrition Discussion List

To my knowledge, most of the studies were small clinical trials with less than 15 people in them so really there does not seem to be enough evidence to recommend vanadium supplements to diabetics.
Shirley Posner
 

I am seeing more diabetic patients lately. Does anyone have information on  monitors and glucose monitoring, such as "GlucoWatch" that scans the skin instead of a needle prick? Thanks

Subject:  Re: blood sugar meters 
Date: 19 May 2001 
From: HIV Nutrition Discussion List - Sharon Ann Meyer
 

Hello Susan,
In the two-part article  "Diabetes Update" that was published in the Nov/Dec 2000 (Issue 27) and Jan/Feb 2001 (Issue 28- in PDF) HIV ReSource Review their were a few products mentioned. Information one that looks useful more than others:

"The GlucoWatch Biographer is a new product designed to check blood glucose levels discreetly and automatically. (119, 120) Worn on the wrist, the device detects both hyperglycemia and hypoglycemia. It can store up to 4,000 glucose measurements. Large scale manufacturing is expected after approval from the FDA in early 2001. "

References
119. GlucoWatch? Biographer Clinical Study Results Presented At American Diabetes Association Scientific Sessions. News Release, San Antonio, TX; 12 June 2000.

120. The GlucoWatch? Biographer. Cygnus, Inc.: Redwood City, CA. Accessed 11 Aug 2000.

I'm seeing a pt on Friday with diabetes and HIV. Does anyone have any suggestions as to nutritional care? 

Jenny Radcliff
 

Jenny, 

I don't know if you got any replies not sent through the list so thought I'd answer you. 

There are a wide variety of issues related to treating HIV-positive people with glucose abnormalities, too many to discuss here. These disorders are becoming more prominent in this population due in part to the wide-spread use of medications used to treat HIV/AIDS. We did a two-part feature "Blood Glucose Abnormalities In HIV-Positive People" in the Nov/Dec 2000 (Issue 27) and Jan/Feb 2001 (Issue 28- in PDF format) HIV ReSource Review.  The article is 17 pages in length and the authors covered: Diabetes, HIV/AIDS and diabetes, hyperglycemia, insulin resistance, medications increasing the risk of glucose abnormalities, selected clinical trials, treatment issues including dietary considerations, methods to meet dietary needs, dietary supplements (such as the one noted at the Nutrition News Focus Web Site) and lifestyle factors. The newsletter is available through the Internet by subscription. Review issue previews at the Newsletter Preview Page and find quicker 
loading abstracts at the HIV ReSource Review Abstracts Page.

Although studies are now beginning to note that diabetes may be prevented with intensive lifestyle change in eating and exercise habits, very few researchers are addressing the HIV population. 

A number of herbs and other supplements can affect blood sugar so I would suggest addressing this topic with patients. The Herb Drug Interaction Handbook has a list of herbs that can affect blood sugar.
Sharon Ann Meyer
 

Can anyone lead me to information on vitamins and minerals in diabetes? Are vanadium supplements helpful? Thanks 
James Hardy
 

Re: Diabetes
Date:  Sat, 15 Feb 2003 22:31:42 -0500
From: HIV Nutrition Discussion List

Hi James, 
As noted in the Jan/Feb 2001 issue of the HIV ReSource Review (PDF preview), "Although vanadium supplementation in diabetes increased diabetic control in Type 2 diabetics, there is an inconsistent response among patients (ODS PDF file). Furthermore, pharmaceutical doses of 25-50 mgs per day are needed and vanadium is toxic at more than 10 mg per day. Vanadium adverse effects include gastrointestinal intolerance and decreased HDL cholesterol." 
Sharon Ann Meyer

I became severely ill in 1980, a few "tears" before they had a test for H.I.V. Doctors tested me prior to that for almost everything under the sun so I truly believe that H.I.V. was the culprit as no other reason for my being ill could be determined. If i remember correctly some mention of a possibility of ("CRIBS"/"CRIBBS") I think was made by the doctors, but it was speculative. Does anyone know if it was called this at one time? My memory fails me on that point. 

I also know for certain that the last relationship I had was two years prior to that so I figure I have been positive some twenty four years, at least. I am curious as to how many others are, "long term survivors". I do not think I am an exception, but I have no reference as everyone I knew has either died or disappeared. I would like to hear from others who are "long term survivors" so that I may compare notes and get an idea of where I stand in regards to the rarity of the length of my illness, and to substantiate weather or not behavior and lifestyles can be determined and possibly attributed credit. 

Thank you for your consideration in replying, and I am willing to "pen pal" with anyone who is in need of communication with another human being.
From Irving

I did a bit of checking but so far no one that I've asked has hear of the term CRIBBS. The earliest name most of us remember is "GRID", gay related immunodeficiency syndrome. 
Sharon Ann Meyer

Subject: Re: Common Ground (was Early Name for HIV)
Date: Sun, 25 Aug 2002 14:08:16 -0400
From: HIV Nutrition Discussion List

You are not alone.  I became ill in 1984.      I assume I was seroconverting.      I was sick from July through December.       In 1985 the fellow I was no longer seeing (I was too sick), died of what was newly described as AIDS DEMENTIA. 

Between 1985 and 1994 I watched my T cells fall from the thousands to less than 100. I also watched most of my friends die. In 1994, I was stricken by the first of seven (7) OI's (opportunistic infections). I was hospitalized for over a year on and off; in and out. In February 1996 I left the hospital for what we all figured was the last time. In my bag of medications was something new. Saquinavir was the first protease inhibitor released in Canada. It saved my life. I have subsequently taken Crixivan and currently eat Kaletra. These drugs create their own problems but they have worked for me. I'm still here. I still have AIDS. 
Jake

"Needs at HIV Food Pantry Grow with Rise in Diagnoses" - Sunday Advocate (Baton Rouge, La.) (08.26.01)::Amy Wold

Four months after opening a Baton Rouge food pantry for people with HIV/AIDS, Volunteers of America (VOA) is looking for more space to meet increasing demand. When the Golden Rule 
Customer Choice Food Pantry opened in April, it was receiving enough Ryan White Care Act funding to provide food for 250 people. Currently, the pantry is serving 300 people, said Dietrich Blair, supervisor of VOA Special Services. The number of people with HIV/AIDS looking for help has increased across the board, he said, from case management to pantry clients. As of June 14, 2,168 people in East Baton Rouge Parish were living with HIV/AIDS, according to the Louisiana Office of Public Health. 

VOA needs more space to store the 20,000 to 23,000 pounds of food it distributes each month from its Wooddale Blvd. building. In addition to looking for a larger facility, VOA is applying for money to purchase an industrial refrigerator to hold perishable items such as milk. Blair said he also would like to purchase more meats, fresh vegetables and nutritional drinks such as Ensure. Three days a week, clients can receive 50 pounds of food with five additional pounds for each person in the house up to 70 pounds. The pantry can spend only about $4,500 a month, and it receives food from the Second Harvest in New Orleans at a cost of $1.10 a box and from the Greater Baton Rouge Food Bank. In 
addition, the pantry tries to reduce waste through a "customer choice" food pantry model. Under the old model, people would receive a prepackaged parcel of food. "What would happen is I would go out on a home visit and I'd see 49 cans of green beans in someone's kitchen," Blair said. With the customer's choice model, customers can pick and choose what they like and need, which means more food goes to people who will use it. The group relies on donations to provide its clients with toiletry and hygiene items, which are not covered under Ryan White funding.
 

Hi, Is there any truth to the rumor that ginger helps with nausea? My medications make me feel like I am going to throw up every time I take them. Also, my wife has morning sickness. 
Thank you. Robert Paul
 

Subject: Re: ginger and nausea/morning sickness
Date: Mon, 11 Mar 2002 11:41:12 -0500
From: HIV Nutrition Discussion List - Sharon Ann Meyer

We recently did some research on ginger, which was published in the HIV Nutrition Update - Issue 33 (a preview in PDF format). Below are article excerpts on side effects/cautions: 

"Taking any drug during the early months of pregnancy is a concern because of unknown risks for birth defects, yet some authorities note that ginger may be worth trying in severe cases of morning sickness. (30)" 

"Many sources deny any side effects stemming from the use of ginger but some sources report that it may cause a sensation of heat and burning in the stomach. (18) In general, there are no known side effects associated with the proper administration of ginger. (8) 

Ginger may interfere with cardiac drug therapy and inhibit blood clotting when taken with chemotherapy. (18, 44) Numerous reports caution that it can inhibit platelet aggregation and increase the risk of bleeding especially for people with a low platelet count (thrombocytopenia) or if taken with anticoagulant drugs such as Coumadin, aspirin, Plavix, Ticlid, Ticlopidine or aspirin (8, 11, 44, 45). Others report that the true risks of these interactions are difficult to characterize because of the small number and nature of existing reports. (46) In any event, small amounts of fresh ginger in cooking should not be a cause for concern. (19) 

People with blood glucose abnormalities should know that ginger is hypoglycemic and may alter blood glucose control. (44) Excessive doses of ginger (six gms a day) increase the exfoliation of gastric surface epithelial cells, which may lead to stomach ulcers. (8) Contact dermatitis has been reported with fresh ginger rhizome while large doses of ginger can cause central nervous system depression and cardiac arrhythmias. (47) 

Although many people take ginger hoping to alleviate common aliments, few consider potential herb-drug interactions. Concerns about food-drug and drug-supplement interactions are increasing. For example, readers may refer to a Washington Post article from April 30th, 2001 that notes many pharmacies now ask customers to fill out questionnaires about their use of dietary supplements. Other authorities are beginning to warn people about cytochrome P450 interactions as well. Even though formal drug interaction studies have not been performed, it may be wise to take ginger at least one hour, preferably 90 minutes, after taking prescribed medications due to cytochrome P450 interactions. The Nov/Dec 1998 HIV ReSource Review issue has more information on this enzyme system. 

Patients should always disclose their use of herbal medicines and nutraceuticals before any surgery is scheduled to avoid allergic reactions and adverse herb­drug reactions. (48) Some authorities note that patients should stop taking ginger at least two weeks before elective surgery because it may increase bleeding after surgery. Other authorities report that it is not likely to cause adverse effects either before or after surgery. (2) 

Wild ginger contains aristolochic acid a toxic compound associated with kidney disorders and certain cancers. (6, 49) People who have gallstones or gallbladder disease should not take ginger because of its ability to increase bile production. (2, 8, 11, 47) The German Commission E and other sources advise pregnant women to either not use ginger at all or to use it for only a short time. (2, 8, 11, 18) Also, the safety of ginger has not been established in nursing women, young children, or people with renal or liver disease. (12)" 

References in the text above:

2. Ginger Zingiber officinale. American Herbal Products Association. Accessed 24 Jan 2001.

6. Duke JA. Dr. Duke's Phytochemical and Ethnobotanical Databases. Chemicals and their Biological Activities in: Zingiber officinale ROSCOE (Zingiberaceae) -- Ginger. USDA - ARS - NGRL, Beltsville Agricultural Research Center: Beltsville, MD. 

8. Ginger. In: Fleming T, Ed. PDR for Herbal Medicines. Second edition. Montvale, New Jersey: Medical Economics; 2000:339-342. 

11. Graedon J, Graedon T. Ginger Zingiber officinale. The People's Pharmacy Guide To Home And Herbal Remedies. St. Martin's Press, LLC. 

18. Zingiber officinale (Ginger). Natural Medical Solutions; 1998 - 2001. Accessed 30 April 2001.

19. Latta SA. Herbs: Ginger. Kansas State University Agricultural Experiment Station and Cooperative Extension Service; March 1999. Accessed 24 Jan 2001. 

30. MEDCHEM 420: Alternative and Complementary Medicines. Accessed 11 Aug 2001.

44. Herr SM. Herb-Drug Interaction Handbook. Church Street Books: Nassau, NY; 2000. 

45. Vickers A, Zollman C. ABC of complementary medicine - Herbal medicine. BMJ 1999;319:1050-1053. 

46. Vaes LP, Chyka PA. Interactions of warfarin with garlic, ginger, ginkgo, or ginseng: nature of the evidence. Ann Pharmacother 2000;34(12):1478-82. 

47. Gyllenhaal C. The Truth About Herbal Supplements. Presentation at the Annual Florida Dietetics Association Meeting, West Palm Beach, FL; 15 July 1998. Accessed online 26 April 2001. 

48. Larkin M. Surgery Patients At Risk For Herb?Anaesthesia Interactions. Lancet Interactive 1999;354(9187). Accessed 26 April 2001.

49. Jackson L, Kofman S, Weiss A, Brodovsky A. Aristolochic Acid (NSCO5O413): Phase I Clinical Study. Cancer Chemother Reg 1964;42:35-37.

Any info on the above? Jean
 

Subject: Re: Glucosamine
Date: Fri, 04 Aug 2000 02:25:52 -0400
From: HIV Nutrition Discussion List - Sharon M. Herr, RD

Hi Jean, Glucosamine may increase insulin resistance (most research is on laboratory animals).

References
> Ross SA, Chen X, Hope HR, Sun S, McMahon EG, Broschat K, Gulve EA. Development and Comparison of Two 3T3-L1 Adipocyte Models of Insulin Resistance: Increased Glucose Flux vs Glucosamine Treatment.  Biochem Biophys Res Commun. 2000 Jul 14;273(3):1033-1041.

> Nelson BA, Robinson KA, Buse MG.  High glucose and glucosamine induce insulin resistance via different mechanisms in 3T3-L1 adipocytes.  Diabetes. 2000 Jun;49(6):981-91

> Monauni T, Zenti MG, Cretti A, Daniels MC, Targher G, Caruso B, Caputo M, McClain D, Del Prato S, Giaccari A, Muggeo M, Bonora E, Bonadonna RC. Effects of glucosamine infusion on insulin secretion and insulin action in humans.  Diabetes. 2000 Jun;49(6):926-35.

> Shankar RR, Zhu JS, Baron AD.  Glucosamine infusion in rats mimics the beta-cell dysfunction of non-insulin-dependent diabetes mellitus. Metabolism 1998 May;47(5):573-7.

> Rossetti L, Hawkins M, Chen W, Gindi J, Barzilai N.  In vivo glucosamine infusion induces insulin resistance in normoglycemic but not in hyperglycemic conscious rats.  J Clin Invest 1995 Jul;96(1):132-40.

> Balkan B, Dunning B.  Glucosamine inhibits glucokinase in vitro and produces a glucose-specific impairment of in vivo insulin secretion in rats. Diabetes 1994 Oct;43(10):1173-9.

> Giaccari A, Morviducci L, Zorretta D, Sbraccia P, Leonetti F, Caiola S, Buongiorno A, Bonadonna RC, Tamburrano G.  In vivo effects of glucosamine on insulin secretion and insulin sensitivity in the rat: possible relevance to the maladaptive responses to chronic hyperglycaemia.  Diabetologia 1995  May;38(5):518-24.

> Glucosamine monograph at The Natural Pharmacist

> Sharon Herr, RD - Nassau, NY - Author: Herb-Drug Interaction Handbook
 

Subject: Glucosamine and Osteoarthritis
Date: Mon, 29 Jan 2001 11:38:14 EST
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Some people take the supplement that is mixed with  chondroitan as it is supposed to help with arthritis in the bone. I've found that it can cause loose stools so it may not be advisable for everyone to try it. I suggest trying the supplement for at least 2-3 months to see if there is any improvement unless loose sttols or other side effects are noted.

This was recently released from Reuters Health on an article in the Lancet.

"Long-Term Glucosamine Sulfate Use Appears to Modify Osteoarthritis 
WESTPORT, CT (Reuters Health) Jan 25 - Among patients with knee osteoarthritis, long-term use of glucosamine sulfate appears to prevent changes in joint structure and significantly improve symptoms, according to a report in the January 27th issue of The Lancet. 

 Dr. Jean Yves Reginster from the University of Liege, Belgium, and colleagues randomized 212 patients with knee osteoarthritis to 1500 mg of glucosamine sulfate, or placebo, once a day for 3 years. At baseline and at 1 and 3 years, the researchers obtained anteroposterior radiographs of each 
knee and assessed mean joint space and mean joint-space width. 

 Among the 106 patients who received glucosamine sulfate there was no significant joint-space loss after 3 years (mean loss -0.31 mm), Dr. Reginster's group reports. However, among the 106 patients in the placebo group, the investigators found progressive joint-space narrowing, with nonsignificant mean joint-space loss of -0.06 mm. The differences in minimum joint-space narrowing were similar, they note. 

 When Dr. Reginster's team assessed osteoarthritis symptoms, using the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, they found that among the patients receiving glucosamine sulfate, scores improved by 20% to 25%, while among patients in the placebo group, scores worsened slightly. 

 Noting that glucosamine is widely available as a nutritional supplement in the US and the UK, Dr. Tim McAlindon from Boston University Medical Center says in a journal editorial that because patients do not rely on physicians for nutritional advice, glucosamine is likely to be self-prescribed, leaving 
the physician out of the treatment loop. 

 "This situation must change," he says. "It is time for the profession to accommodate the possibility that many nutritional products may have valuable therapeutic effects and to regain the credibility of the public at large."

It should be noted that subjective reports have noted an increase in stool output and loose stools when using this supplement.

Subject: Glucosamine and Osteoarthritis
Date: Fri, 15 Jun 2001 06:23:02 -0700
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Also, on the subject of Glucosamine and Osteoarthritis, this article has some information:
Chard J, Dieppe P. Glucosamine for osteoarthritis: magic, hype, or confusion? BMJ 2001;322 1439-1440
 

Just sharing the final worksheet, which was submitted to the National HIV Nutrition Guidelines  Working Group on the Shabert glutamine study.

Nutrient Research Data Collection Worksheet: Functional Supplements- Glutamine-4

Reference 
(CID style first page, author/date subsequent pages) Shabert JK, Winslow C, Lacey JM, Wilmore DW. Glutamine-Antioxidant Supplementation Increases Body Cell Mass In AIDS Patients With Weight Loss: A Randomized, Double-Blind Controlled Trial. Nutrition. 1999;15(11-12):860–864.

Data Collector/Date Collected: Data Collector- Denise DeTommaso    Date: 5/29/01
                                                      Data Collector- SAMeyer    Date: 6/13/01

Functional Supplement- Glutamine

Design of study- O Cross section  O Prospective  X Placebo   O Untreated Group   O Observational     O  Retrospective  X Double Blind  O Counseling Control Group              O Sample Size Analysis
O Antiretroviral Control  X Open Label after completion of the blinded trial 4 subjects received the supplement.  O Viral Load Monitored     Other:  Randomized    O CD4 Monitored      O Longitudinal

Diet Tool Assessment- O 24 Hour Recall  X Food Frequency (Willett)  X Day Food Record: including consumption of vitamin, mineral, other nutritional supplements, alcohol and recreational drug use.
O 1   O 2  X 3  O 4  O 5  O 6  O 7  O other: Weekly Nutritional Counseling_"to ensure stable and adequate nutrient intake".  X Baseline : 3 day food diary, Willet Food Frequency
O Follow up at: Weekly counseling, 3 day food diary at onset and at end of 3 month period

Identified Side Effects- None
Identified Drug/Food/Herb/Other nutrient interactions-None

Inclusionary Criteria- Plus HIV, Minus opportunistic infection, > 5% unintended loss of usual body weight or < 90%standard creatinine/height index., medically stable; not been on other protocols or received other experimental meds for at least 2 months before the study; if receiving B12 or folate, they must have received these vitamins for at least one month before starting the trial; if using testosterone, they must have received it for 4 months or more before entering the trial and continued it at the same dosage throughout the trial; if using NAC, they had to discontinue it; if using ascorbic acid, they continued to take it at the usual dose. 

Exclusionary Criteria- Opportunistic Infection, cirrhosis of the liver, renal failure, chronic diarrhea 2nd to infection, current use of more than 5.0 g/d glutamine supplement.

Population-  Baseline n=: 26
Follow up n =: 21
HIV:  21 M: 19  F; 2
Age- mean: 42 placebo  40 treatmt grp   placebo grp- M: 8  F: 1    treatmt grp-  M: 11 F: 1

No HAART info- See below Baseline mean:

ART or other medication note: of the 21 who finished the study, all but 3 were taking antiretrovirals Baseline mean- placebo grp 8 subjects/19 antiretrovirals + 4 subjects/4 PIs + 1 subject/testosterone
treatmt grp 10 subjects/21 antiretrovirals + 6 subjects/7 PIs + 1 subject/testosterone

Viral Load Baseline mean:  No info

CD4 Baseline mean:    placebo grp 183 (13-364)                               treatmt grp 147 (1-327)

How monitored-  Wt/kg Baseline mean- placebo grp 71.6 ? 11.2      treatmt grp 68.3 + 8.3
                              Follow up mean- placebo grp 71.9  ?11.2               treatmt grp 70.6 + 8.9

BMI Baseline mean:     placebo grp 22.9 (19.9-24.9)                         treatmt grp  22.2 (19.5-25.5)

BCM (BIA)  Baseline mean:  placebo grp 28.4 ? 6                            treatmt grp 26.9 + 4.4
                  Follow up mean: placebo grp 28.8 ? 6.1                        treatmt grp 28.6 + 4.6

Intracellular water (L): Baseline mean- placebo grp 25.9 ? 5.4         treatmt grp 25.6 ? 4.7
                                         Baseline mean- placebo grp 26.5 ? 5.5          treatmt grp 27.3 ? 5.0
Extracellular water (L):   Baseline mean- placebo grp 17.3 ? 2.9      treatmt grp 16.7 ? 1.3
                                         Baseline mean- placebo grp 17.0 ? 2.8          treatmt grp 16.4 ? 1.8

Fat Mass: Baseline mean- placebo grp 11.9 ? 4.6                                 treatmt grp 10.6 + 3.4
                  Follow up mean- placebo grp 10.6 ? 3.4                               treatmt grp 10.9 + 2.7

Intake (Kcal): Data for 16 subjects Baseline mean: 2256                  Follow up mean: 2376

Protein g (total): Data for 16 subjects Baseline mean: 101.5            Follow up mean: 106.9

CHO g/d: Data for 16 subjects Baseline mean: 298                           Follow up mean: 322

Fat g (total): Data for 16 subjects Baseline mean: 75.4  Follow up mean: 76.6

Hypothesis: Glutamine- Antioxidant supplementation can increase body cell mass, and intracellular water when compared with placebo supplementation. Glutamine supplementation and select antioxidants can "satisfy an increased glutamine requirement as occurs with weight loss and thus reverse the loss of body cell mass in patients with AIDS".

Intervention: Subjects received Glutamine-Antioxidant (40g/day) in divided doses or glycine(40g/day) as the placebo for 12 weeks. All patients received "a daily vitamin and mineral preparation equal to the RDAs to ensure intake of these micronutrients." Along with the glutamine, the treatment group received "selected antioxidant nutrients (ascorbic acid 800 mg/d, alpha-tocopherol 500 IU/d, beta-carotene 27,000 IU/d, selenium 280 µg/d and NAC 2,400 mg/d" in four divided doses." ..."used packets were returned to monitor compliance."  The subjects were seen weekly by a nutritionist, and body weight, and bioelectric impedence assessment, and nutrition counseling performed.

Findings: Provision of glutamine with a specific nutrient supplement and nutritional counseling can improve weight and restore BCM. The glutamine supplemented group gained 2.2 Kg in body weight(3.2%) whereas the control group gained 0.3 kg(0.4% p=0.04 for difference between groups).  The glutamine supplemented group gained 1.8 kg in body cell mass whereas the control group gained 0.4 kg.  Intracellular water increased in the glutamine supplemented group but not in the placebo group. "Additional kinetic measurements are required to delineate the specific mechanisms involved and also determine the role of the antioxidant nutrients in these subjects."

Comments: Per study investigators:
Glutamine-antioxidant supplementation can increase body weight, body cell mass, and intracellular water.  This provides a cost effective therapy for rehabilitation of HIV+ patients with weight loss. Protein kinetic studies done by other investigators (Yarasheski KE, et al.) demonstrating increased proteolysis and synthesis rates in asymptomatic individuals coupled with the results of this study suggest that glutamine is a critical nutrient in HIV and continous provision of glutamine seems warranted. "Larger multicenter studies are needed to determine whether glutamine-antioxidants will support BCM and reduce the incidence of infection over the long term"...

Not identified in study: Identified Drug/Food/Herb/Other nutrient interactions 

Not identified in study: Side effects known or suspected
A. Glutamine may be contraindicated in people with either hepatic or renal dysfunction: 
   i-.Herskowitz K, Souba WW. Intestinal Glutamine Metabolism During Critical Illness: A Surgical Perspective. Nutrition 1990;6(3):199-206.
   ii-.Souba WW, Herskowitz K, Austgen TR, Chen MK, Salloum RM. Glutamine Nutrition: Theoretical Considerations And Therapeutic Impact. JPEN. 1990;14(4 Suppl):237S-243S.
   iii. Ziegler TR. Glutamine Supplementation In Catabolic Illness. Am J Clin Nutr. 1996;64(4):645-47.

B. People may experience changes in mental status such as lethargy or mania or even encephalopathy. We do not know if supplemental glutamine is bioavailable or if intestinal absorption is identical to that of glutamine released in the final stages of protein digestion: 
   i. Noyer CM, Simon D, Borczuk A, Brandt LJ, et al. A Double-Blind Placebo-Controlled Pilot Study Of Glutamine Therapy For Abnormal Intestinal Permeability In Patients With AIDS. Am J Gastroenterol. 1998;93(6):972-75.
 
 

Subject: glutamine
Date: Wed, 25 Sep 2002 13:56:38 -0400
From: HIV Nutrition Discussion List 

Hello, 
Could you please advise me on the proper dosing of l-glutamine for a PWA with 180 t-cells and a viral load of about 40,000,  with no OI's, and symptoms of fatigue, lipodystrophy, moderate wasting and occasional diarrhea. My local AIDS service organization provides me with 120 capsules per month, each being 750 mg. Of course the bottle is vague - telling me to take 1-6 capsules daily. I'd appreciate your assistance, thank you very much, Jim
 

Subject:  Re: glutamine
Date: Thu, 26 Sep 2002 15:28:48 -0400
From: HIV Nutrition Discussion List

I was told to take 5 grams twice a day for diarrhea. I think it depends on how much diarrhea you have so you might want to see a nutritionist to find out what is good for you. 
Todd Finney
 

Subject: Re: glutamine
Date: Mon, 30 Sep 2002 12:51:48 -0400
From: HIV Nutrition Discussion List

In the Sept/Oct 1999 HIV ReSource Review, it was noted that: 

"Minimum dosage levels are between 20-30 gm per day of 100% glutamine taken in divided doses at mealtimes." "Although dosing is adjusted individually based on body weight and condition, standard dosing practice for PLWHIV is 0.57 gm of glutamine per kg of actual body weight." "Glutamine powder is recommended as you would need up to 60 tablets to get 30 gm of glutamine." 

"All glutamine products are not the same so it is important to check the purity and source of purchased glutamine. The powder is white, tasteless and dissolves easily in liquids such as water or juice, or in moist foods such as applesauce or oatmeal. Besides its use in enteral and parenteral feedings, powered glutamine can be blended with shakes, fruit coolers and clear juices when GI tolerance is diminished. Oral glutamine should always be taken in divided doses several times a day. Frequent doses optimize contact with the enterocyte and maximize the benefits of supplementation. Glutamine can be taken on an empty stomach. It should be consumed within an hour, or refrigerated and used within 24 hours." 

"Glutamine may be contraindicated in people with either hepatic or renal dysfunction." 
  Sharon Ann Meyer
 

Any information on the above supplement?? Thanks  Lori Mercier

Subject: Re: GUGGUL
Date: Sun, 17 Sep 2000 23:47:19 -0400
From: HIV Nutrition Discussion List

I have had quite alot of interaction with athletes using guggulsterones for fat-loss over the last year or so.  I often recommend it to those who have a stubborn metabolism, and show signs of Euthyroid Sick states.  Most people who do not respond very well to diet and exercise modification 'tricks" actually show quite a response in fat loss, quite specific too (skin caliper measures as well as BIA).  I currently have 4 clients taking the supplement.  2 have just begun, and 2 for the past 2-3 months (and still making significant losses).  But I have only had experience with one brand: the Syntrax's Guggul Bolic.  As well, some have complained about a temporary GI upset for the first initial week (introduction to the substance), but eventually it subsided.  The program is 1 capsule (500 mg Guggul extract or 30 mg alkaloid content) per day for the first 5-7 days for tolerance, then proceed to increase
gradually to TID (1500mg extract/90mg alk). 

Although the observations were for fat-loss only.   I know of two recent human studies on fat loss and very little muscle atrophy during low-calorie dieting/moderate physical activity, showing very
interesting results. One is a pilot study which was to be an eventual lead-in to the second study.
Thanks, Jason
 

Subject: Re: GUGGUL
Date: Mon, 18 Sep 2000 22:27:10 -0400
From: HIV Nutrition Discussion List

Hi Jason, "Euthyroid Sick states", does that mean low thyroid? If so, are they getting meds for that or is the guggul used instead of synthroid? 
Sharon Ann Meyer
 

Does anyone recommend guggul as a low-density lipoprotein (LDL) cholesterol-lowering,  high-density lipoprotein (HDL)-cholesterol raising supplement? 
Jeri Page
 

Subject: Re: [Hivnutritiondiscussionlist] guggul
Date: Wed, 15 Oct 2002 13:22:14 -0500
From: HIV Nutrition Discussion List

We covered guggul in the Nov/Dec 2000  (Issue 27)  HIV ReSource Review issue. It is known as Guggal, Guggul, Guggulipid, Guggulu Gum, Guggal Gum, Guggulu, Gugulipid, Commihora wightii, C. Mukul, Indian Bdellium-Tree, Indian myrrh tree, and  Mukul Myrrh. An abstract of the article is at the Alternatives Abstract Page. 

It is important to know that "Researchers note guggul must be used with caution by people taking heart medications such as propranolol (Inderal) and diltiazem (Cardizem) because it causes a significant reduction in bioavailability and can reduce therapeutic effects. (28) " 

Reference 28:  Dalvi SS, Nayak VK, Pohujani SM, Desai NK, et al. Effect Of Gugulipid On Bioavailability Of Diltiazem And Propranolol. J Assoc Physicians India. 1994;42(6):454-455. 
Sharon Ann Meyer

Hi, Does anyone recommend guggul for cholesterol problems? Can you lead me to any research reference(s) on it? Thanks -- James Hardy
 

Subject: Re: guggul
Date: Sat, 01 Feb 2003 16:37:40 -0500
From:  HIV Nutrition Discussion List

This is something I saved from one of my lists but it doesn't have references. I bet you could search at Medline for references. 

Guggul Lipid: Circulation stimulant lowers cholesterol and thins blood Guggul is a gummy yellowish resin (Commiphora mukul) plant extract from India. It is clearly a cardiac tonic that strengthens muscle, nerve, and bone tissue. It's properties are similar to niacin and fish oil. It clears cholesterol from arteries and veins, lowers triglycerides and breaks up hardening and stagnation. It builds the
lymphatic system as well as the immune system and reduces inflammation; the list goes on. This is a very impressive herb; it has been described as "probably the most powerful cholesterol lowering herb known". And, oh yes, it often stimulates gradual weight loss. 

Contains 500 mg of Guggul Lipid standardized to contain 25 mg of guggulsterones per gram. About 1% will experience a mild allergic skin reaction. 
Reba Mackie
 

Subject: Re: [Hivnutritiondiscussionlist] guggul
Date: Sat, 01 Feb 2003 18:22:14 -0700
From: HIV Nutrition Discussion List - Sharon Ann Meyer

We noted some information on this herb in an earlier message. Check the Main Archive Page for a list of topics already discussed on the list.

I saw something in our newspaper where someone is baking bread with hemp seeds. The article said these were higher in omega 3s than other seeds. Anyone know anything about this? Thanks 
Jenny Morrison 
 

Subject: Re: Hemp seeds?
Date: Thu, 23 Jan 2003 16:29:34 -0500
From: HIV Nutrition Discussion List - Sharon Ann Meyer

I have not seen any replies to this query so I don't know if anyone answered it by just emailing the person who wrote it. Anyway, I answered a question very similar to this one a while back. I hope it answers your question: There's a web site to go for more information on hemp. 

See my previous response on hemp below. 
 

I just saw something about baking bread with hemp seeds. Are they really higher in omega 3s than any other seed? Thanks! 
Shirley Washburn 
 

Subject: Re: Hemp Seeds
Date: Wed, 23 Oct 2002 19:34:53 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

As noted in Issue 23 of the HIV ReSource Review: 
"Hemp, another form of marijuana grown for its fiber, seed and pulp, has very little THC. (1) Some studies show hemp seeds to be a nutritious food with high quality protein, which can be used as flavor enhancers once they are cleaned and roasted. (38) The protein in hemp is mainly edestin similar to the albumin found in egg whites and blood. (9) Hemp seeds are still used by several cultures including the Chinese, Japanese and Jamaicans. Legal hemp seeds are sterilized by heat or steam and excluded from the definition of marijuana. Hemp oil is said to consist of up to 81% polyunsaturated essential fatty acids, which include 1.7% gamma-linolenic acid, and a perfect 3:1 ratio of omega-6 linoleic acid to omega-3 Linolenic Acid. (1) This oil is best used as a salad dressing or butter and margarine substitute for dipping bread. (9) It is currently twice the cost of flax oil. 

References 
1. Mathre ML, ed. In: Cannabis In Medical Practice. Jefferson, North Carolina: McFarland & Company, Inc., Publishers; 1997. 

9. Clarke RC, Pate DW. Economic And Environmental Potential Of Cannabis. Mathre ML, ed. In: Cannabis In Medical Practice. Jefferson, North Carolina: McFarland & Company, Inc., Publishers. 1997;17:192-211. 

38. Wirtshafter D. Nutritional Value Of Hemp Seed And Hemp Seed Oil. Mathre ML, ed. In: Cannabis In Medical Practice. Jefferson, North Carolina: McFarland & Company, Inc., Publishers. 1997;16:181-191. 
 

I am taking garlic but one of my friends told me it decreases saquinavir blood levels. Since I also take saquinavir and a few other meds I wanted to know if this was true. Is it? Thanks in advance. 
Michelle Dryer
 

Subject: Re: Garlic
Date: Wed, 19 Mar 2003 17:40:22 -0500
From: HIV Nutrition Discussion List

Yes, Michelle, garlic does affect saquinavir levels. It would be a good idea to let your health care provider know you are taking it. For more information visit the CID Journal. 

Garlic may affect other medications as well. In the Jan/Feb 2001 HIV ReSource Review issue Sharon Herr, RD, discussed the many interactions between herbs and drugs in her Herb Drug Interaction Handbook. Here is an excerpt on garlic: 

"Garlic (Allium sativum): Interactions with garlic generally only occur when it is taken in supplements or large quantities of garlic cloves.Garlic consumed in cooking is generally not of sufficient quantity to cause interactions with drugs unless there is a preexisting bleeding problem. Garlic's potential to lower serum lipids may be additive (research on this effect varies). When garlic supplements or large quantity of cloves are consumed while taking lipid lowering drugs such as atrovastatin (Lipitor),
fenofibrate (Lipidil), fluvastatin (Lescol), gemfibrozil (Lopid), Pravastatin (Pravachol), and simvastatin (Zocor), or niacin (Niaspan) lipid levels may be lowered further. (41,148) A recently approved drug Baycol (cervistatin), a lipid lowering drug in the above class, will exhibit the same effect. High intake of garlic has the potential to inhibit the uptake of iodine by the thyroid gland, so caution should be used with concurrent thyroid replacement therapy. (35,103,106) Garlic has the potential to increase bleeding (see Table 3) and lower glucose (see Table 2). See the Sept/Oct 1998 Review issue for more information on garlic." 
Sharon Ann Meyer

Please guide on which micronutrients/nutraceuticals I should provide to my clinic patients with HIV. I shall be obliged for the help. 
Dr.Sandeep Saluja (internist) 
C 38 Soami Nagar 
New Delhi 110017 
 

Subject: Re: micronutrients
Date: Wed, 16 Oct 2002 16:27:31 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Dietary supplementation really needs to be individualized. Generally, if liver enzymes are within range we suggest: 
multivitamin twice a day with breakfast and dinner 
antioxidant and B-complex with lunch 

Minerals should NOT be given unless deficiencies are apparent. 
 

Subject: Re: micronutrients
Date: Tue, 20 Aug 2002 12:43:26 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Hello Doctor Saluja,
This was forwarded to me. Micronutrient supplementation is a very big topic. Along with the answer I sent previously, you can follow the links at HIV ReSources for information on nutrition and HIV. Some clinicians purchase materials through this site. 

HIV ReSources publishes the HIV ReSource Review (Issues 1-30) and HIV Nutrition Update (Issues 31+) to help students and healthcare professionals provide effective nutritional services to HIV-positive people. We are covering food-drug interactions in a two part issue Sept through December of this year. 

Since the newsletter builds upon previously published issues, more than 70% of our current subscribers started their subscription with Issue 1. Visit the Sample Page to read the first issue of the HIV Nutrition Update. 

Also, there's the HIV Nutrition News Update Electronic Newsletter that is a FREE weekly review of news related to nutrition and HIV/AIDS sponsored by HIV ReSources and edited by myself. It summarizes recent scientific reports and news related to nutrition and the field of HIV/AIDS. To see previous posts or to subscribe visit the Archives.

Subject: Mitochondrial Damage
Date: Fri, 18 Oct 2002 07:40:23 EDT
From: HIV Nutrition Discussion List

One of my HIV + patients asked me what to do about mitochondria damage. Her doctor told her that her current medication regime is killing the mitochondria in her body's cells. Is there a nutritional intervention to aid in recovery? Thanks 
Sara Jane 

Subject: Micronutrients (to Help Prevent Mitochondrial Damage)
Date: Fri, 18 Oct 2002 08:00:16 EDT
From: HIV Nutrition Discussion List

I thought this article at The Body had an excellent summary of the nutrients we should be getting to help prevent damage from HIV drugs. 
 

Subject: Re: Micronutrients
Date: Fri, 25 Oct 2002 15:31:11 -0700
From: HIV Nutrition Discussion List

You will find a great deal of practical information on the nutritional aspects of managing HIV disease at Jennifer Jensen's Web Site.  With specific reference to the question of micronutrients and nutraceuticals. I suggest perusing the topics on the Q&A page and looking at "Wasting Syndrome", 
"Antioxidants", "Diarrhea Remedies", "Whey Protein",  and "Lipodystrophy" among others.
Administrator - Jennifer Jensen's Nutrition Power
 

I am hiv positive and taking trizivir, zithromax, diflucan and sulfameth. I am looking for a good vitiman that I can take. Can you recomment one. I am also looking for alternative treatment. I am in
 the Chicago area. Thanks.  Art

Subject: Re: Hiv vitamins and alternative treatments
Date: Tue, 18 Mar 2003 23:12:11 -0500
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Hello Art,
Vitamins (micronutrients) were talked about last year. To see previous posts on vitamins (micronutrients) visit the Archives. Most people take a store-brand multivitamin such as Walgreen's because it's cheaper. Since I don't know your history, what medications you take, or what secondary conditions you have it is impossible to give you individual advice. I suggest you see a dietitian in your area. In Chicago, there's the Core Center, which has excellent dietitians. If it's not close to you they can refer you to a facility that is. Contact information: Cook County Bureau of Health, 2020 West Harrison Street, Chicago IL  60612, 312/572-4602. Their web site has more information about the organization.

Stay Well :-)
 

Subject: Re: Hiv vitamins and alternative treatments
Date: Sat, 22 Mar 2003 14:48:34 -0500
From: HIV Nutrition Discussion List - Nancy Albright

Art,
Check out the ConsumerLab web site as well. They did an overview of the daily MVI and mineral supplements in the past year. If for some reason they upset your stomach try taking with food first and if must try a chewable kids version. Fairly comprable to the adults except they didn't have selenium last I checked. Good luck Nancy Albright RD, CNSD, LD/N
 

Subject: Re: Hiv vitamins and alternative treatments
Date: Sat, 22 Mar 2003 15:43:13 -0500
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Also, if you are taking vitamins take them with food and always 90 minutes apart from any medications to lessen the chance of adverse side effects.

Dietary Supplement and Micronutrient Resources

The Micronutrient Initiative specializes in addressing micronutrient malnutrition. See Reports from The Micronutrient Initiative on the Internet. IBIDS UPDATE has thousands of citations pertaining to dietary supplements. Database records offer information on published research of vitamins, minerals, herbs and botanicals. 
 

To access this online tutorials, go to the Nu Connexions web site. 

Hope this gets our collective creative juices going!  I'd love to hear about other innovative ways people are taking their expertise to the web, or how they use it to enhance their professional growth and development. 
Steve Kinsley, RD, MCNE 
Nu Connexions: "Connecting people....with people....with nutrition information." 

"Diet, Alcohol Linked to HIV-Related Fat Deposits" - Reuters Health (10.02.01)

Dietary levels of fiber, alcohol and fat may play important roles in lipodystrophy, the abnormal body-fat distribution seen in some HIV patients, according to a new report. The condition can cause sunken cheeks, increased fat around the waist and the development of a fat pad on the back of the neck. 

While various metabolic problems have been found in HIV patients with lipodystrophy, and certain HIV drugs are linked to the condition, it remains unclear how the abnormality arises. But the new study's findings suggest that some dietary changes might help HIV patients with the problem. The research, conducted by Dr. Colleen Hadigan of Massachusetts General Hospital in Boston and colleagues, was reported in Clinical Infectious Diseases (2001; 33: 710-717).

"Our data indicate that certain modifiable components, such as polyunsaturated fats, fiber and alcohol, are strongly associated with insulin resistance and [high cholesterol] among these patients," Hadigan and colleagues concluded. The researchers examined the associations between dietary habits, 
metabolism and body composition in 85 men and women with HIV and body-fat redistribution. They questioned the patients on their eating and drinking habits in the previous month, and they examined them after a day of fasting.

The researchers found that low fiber and high polyunsaturated fat intakes were linked to insulin resistance among the patients. Insulin resistance, a problem with the body's use of insulin, is one of the metabolic disturbances seen in HIV patients who develop lipodystrophy. In addition, heavier drinking 
was associated with higher levels of LDL ("bad") cholesterol. These dietary associations with metabolism and lipodystrophy were independent of factors like patients' age and sex, and length of 
time on protease inhibitors, which are believed to contribute to the condition.

The authors called for studies to determine whether changing patients' fat intake, increasing fiber consumption and reducing alcohol would affect the metabolic factors associated with lipodystrophy.
 

I have fallen in love with a man that is HIV positive. We are wondering what his nutritional requirements are.  Are they different than people who are HIV-negative? Thanks 
 

Re: Nutritional Needs
Date:  Sun, 25 Aug 2002 14:15:14 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Nutritional needs for HIV-positive people are usually different than for those who are HIV-negative. It is an individual thing but usually both energy and protein needs are increased depending on the stage of infection and secondary conditions. There may be an increased need for micronutrients as well. Please contact me personally and if you let me know what area you live in I can  refer you to a HIV- savvy nutrition professional who can answer your question more fully. Visit our Questions & Referrals Page for a list of Nutrition Professionals.

Subject: Nutritional Needs
Date: Sun, 25 Aug 2002 17:44:27 -0400
From: HIV Nutrition Discussion List 

Spare the salt, sugar and animal fats. 
Jake

Subject: HIV Nutrition News Listserv
Date:     Sun, 06 Oct 2002 12:20:27 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

An excerpt from the October 4, 2002 HIV Nutrition News Update:

ANSA Nutrition Guidelines
The Nutrition Committee of AIDS Nutrition Services Alliance (ANSA- now the Association of Nutrition Services Agencies) has completed the revision of Nutrition Guidelines for Agencies Providing Food to People Living with HIV Disease. In March 1999, the ANSA Board of Directors approved the original Nutrition Guidelines for Agencies Providing Food to People Living with HIV/AIDS.  The purpose of the Guidelines was to educate agencies about how to provide their clients with quality assurance, quality food and services. 

Keeping with the spirit of the original document, the second edition builds upon the foundation of quality improvement and serves as a comprehensive guide to organizations whose primary mission includes the provision of nutritional services to people living with HIV disease. These services may include, but are not limited to: meal delivery; grocery items; and congregate-type meal programs; as well as nutrition counseling and education. These Guidelines are to be utilized by staff members of
organizations who provide these services. 
 

Subject: HIV Treatment for Patients
Date: Mon, 13 Jan 2003 12:24:16 -0500
From: HIV Nutrition Discussion List

I have a consult with a patient who has HIV. Does anyone have any suggestions as to what the course of nutritional therapy is? Thanks 
 

Subject: Re: HIV Treatment for Patients
Date: Tue, 14 Jan 2003 12:54:03 -0500
From: HIV Nutrition Discussion List - Sharon Ann Meyer

HIV is now considered a chronic manageable disease treated with antiretrovirals and health care including nutritional therapy.  One reliable source of information is the HIV/AIDS Dietetic Practice Group of the American Dietetic Association. Another group ANSA also has a variety of links to online organizations and resources.

HIV ReSources Inc. also has a number of tools to help you learn about HIV and AIDS. They are:

1. Free HIV Nutrition News Update
This is a free weekly review of news related to nutrition and HIV/AIDS. Previous issues of the update are available through the archives at the HIV ReSources web site. 

2. Free HIV Nutrition Discussion List - This List
The HIV Nutrition Discussion List was originally housed on beseen.com in a bulletin board format. Check the Nutrition and HIV Discussion Area Archive Menu as it lists All of the topics that have been discussed.

3. HIV Nutrition Update Newszine
HIV ReSources houses the subscription-based HIV Nutrition Update (Issues 31-54). View the HIV Nutrition Update Editorial Board member list and a full sample issue of the HIV Nutrition Update. 

4. HIV ReSource Review (Complete Nutrition Education Binder)
Visit the web site to see the subjects covered, which includes the Editorial Board. 
 

There are many special concerns in caring for HIV-positive people. Some of them are listed in this PDF file in a timeline form of what was been and may come to be.  People with HIV should be treated differently than those with conditions other than those in people without HIV. 

We all need to continue to point out the differences in care and try to increase awareness in health care providers that may be treating these patients. Without the clinician's knowledge of their patient's HIV status, they can be doing them a great disservice by not keeping up with the research on HIV/AIDS and therefore treating them effectively. We must first increase awareness to the point where everyone realizes that the incidence of HIV/AIDS is more than they are aware of. I think perhaps, one of the first steps is to point out the incidence of HIV among those with hepatitis, heart disease, diabetes, osteoporosis, cancer, substance abuse, lipodystrophy, etc.
 

Hi, 
I just got a new job and will be starting a nutrition program. Do you have any information on nutrition programs for people with HIV/AIDS? I need to know what to do. Thanks
 

Subject: Re: Nutrition Programs
Date: Sat, 31 Aug 2002 11:01:42 -0400From: HIV Nutrition Discussion List - Sharon Ann Meyer

Visit the ANSA web site for information on nutrition programs. They have a technical assistance program for members and lots of other benefits. 
 

Has anyone on this list tried adding protein drinks to your diets?  They seem rather expensive to me, and they don't always mix very easily or taste very good. Anyone have a favorite brand they'd like to share with the rest of us? How much does it cost, etc?  Are there any states that cover this under ADAP? Thanks. 
 

Subject: Re: Protein drinks
Date: Mon, 09 Dec 2002 09:46:18 -0500
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Hi, 
In answer to your query on protein supplements: Yes, they are expensive. Many people get them from food banks or other food programs. I can refer you to one in your area if you'd like. If you do not have lactose intolerance you might want to try carnation instant breakfast, which is cheaper than most and better tasting than many. The powered kind is cheaper than the canned. Boost is good but has a lot of sugar. There are also a number of canned supplements that you can buy at the grocery store for
about $1 a can. You should however, see a nutritionist to see what kind of a supplement may be best for you. There are some specialized supplements that are covered by ADAP depending on where you live. Check with your local HIV Planning Council to see what ADAP covers. Visit this ADAP web page for more information.
 

I had a client ask about a yeast free low sugar diet to help with control of candida (thrush). I discouraged this but wondered if anyone has experience with clients trying this type of diet regimen.Thanks

Subject:  Re: yeast free diet for HIV client
Date:  Mon, 28 May 2001 10:04:57 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Candida albicans is a type of yeast that is normally in the body and usually does not cause any problems. An overgrowth of yeast can occur during or after the use of antibiotics. The yeast-free low sugar diet has been around for ages. We did an article on it in Issue 12 (May/June 1998) HIV ReSource Review issue. Some people swear it works while others say it doesn't. Depending on whose advice you follow, the diet can be very restrictive. There is a lot of information on this diet due to a popular book (The Candida Connection) by Dr. Crook a pediatrician. There is a web site with information related to him as well. Most yeast-free diets restrict refined flours and sugars that are said to encourage the growth of yeast in the body. Foods with yeast such as bread and fermented and aged products such as cheese are discouraged. Some people with thrush and women with vaginal yeast infections have followed this advice with success but there are no scientifically validated studies to support the diet at this time. Many doctors prescribe antifungal medication to get rid of candida. Probiotics also help heal to promote the growth of beneficial bacteria and lessen the overgrowth of yeast. 

Obviously, if you are considering this diet it is best to discuss it with your doctor first. As so many foods are restricted it may be difficult to get all the nutrients needed for normal body functions. 

Subject: yeast free diet: 
Date: Wed, 14 Aug 2002 14:57:59 -0400
From: HIV Nutrition Discussion List -  Ginger

We have an ongoing oral candidiasis study here at our clinic in the dental division. Here is insight I can offer you:

Some types of pseudomembranous candidial lesions worsen in pH>5, but not all types. And yes, theoretically, sugar (CHO) will promote candida growth, but I think it is important to prevent malnutrition in patients with a poor intake, as thrush itself is not a life-threatening condition, whereas malnutrition can be. Also, oral candidiasis is associated with advancing disease (lower CD4 cells), so recurrent thrush can be a problem even after successful treatment with antifungals if the underlying immunosuppression does not improve. Protease inhibitors actually help battle candidiasis directly 
because C. albicans uses a protease in it's colonization. Of note, HIV+ smokers will get thrush with higher CD4 cell counts (<500), so smoking cessation helps decrease incidence of thrush. Hope this helps! My opinion, encourage lower sugar intake, but don't restrict their diet when they have a poor intake - the sugar will not make that big of a difference. 
 

Where can I find out about a yeast free low sugar diet to help with control of candida (thrush). Does anyone have experience with this type of diet regimen?

Subject: Re: Yeast-free diet
Date: Sun, 08 Jun 2003 19:57:38 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Please check the archive for information on this topic. The address is in the welcome message that you got whe