Dr. Smith with Your Health - Advances in Dietary Management of HIV

Advances in Dietary Management of HIV

Dr. Brian A. Smith, D.C.

The importance of adequate dietary protein of a high quality can not be emphasized enough when it comes to managing an HIV infection. Protein is required by the body to produce antibodies, cell walls, immunoglobulins and interferons.

Proteins are made of strings of amino acids linked by chemical bonds. In the human, amino acids are present in certain ratios. Some of the amino acids can not be made by the body, these are the essential amino acids. We must obtain these in the diet. The other amino acids can be made by the body and are considered non- essential. Proteins are rated according to the ratio of the essential amino acids, and their ability to be absorbed and utilized by the body. This measurement is called the Protein Efficiency Ratio, or PER. You may see reference to a products PER on the side of some weight-gain supplements. In our diet the foods that have higher PER's, and therefore are a higher quality protein source, are eggs, meats, poultry and certain dairy products. Vegetables, grains, cereals and fruits contain lower quality proteins. Through combining of certain low quality proteins, one can obtain a high quality intake, for instance pinto beans and rice. Unfortunately, this approach also contains very high amounts of carbohydrates which can be immunosuppressive over an extended period of time.

Recently reported in the Journal of Nutrition (123: 803-810, 1993), the degree of protein deficiency in a diet directly affects the antioxidant enzyme systems in our body. These systems are depressed and include superoxide dismutase (SOD) and glutathione peroxidase (GSH). Many of you will be familiar with glutathione as much research has centered around the depressed levels of glutathione found in HIV+ persons. (Lancet, 27 Jan. 1990, 335:235; and Biological Chemistry HoppeSeyler, 369: 143-148, 1989) and the ability of NAC to restore these levels (Proceedings of the National Academy of Sciences, 10 Feb. 1991).

Without adequate amounts of glutathione, certain immunological chemical pathways are impeded. Stimulation of the immune defenses is impaired and an increased susceptibility to infection results.

Glutathione is required to transport amino acids into the cell. As glutathione levels drop, the ability of amino acids to enter the cell decreases. With less amino acids entering the cell, there is less "working material" for the cell to maintain the cell wall, make immunoglobulins and interferons, and replicate. In theory, this lack of amino acid uptake could lead to the increased serum protein levels which is commonly seen.

The Journal of Nutrition (122: 723-727, 1992) suggests that protein energy malnutrition (PEM) is an independent source of disease in the HIV+ person. Body cell mass is usually depleted out of proportion to losses in body weight or body fat. Further, death occurs when the body weight approaches 66% of ideal body weight and is not dependent on the cause of wasting.

The development of PEM may be caused by several mechanisms. Food intake may be altered as a result of oral or esophageal lesions as well as central nervous system problems. Chemicals released in the body that suppress the appetite are found in cases of widespread infection in the body and in some cases of malabsorption. Damage to the small intestine by a protozoal infection can result in malabsorption. Even with adequate nutrition protein wasting and metabolism derangements are seen with severe inflammatory disorders.

Lean body mass has been shown to increase through oral feeding in patients without malabsorption. Both skeletal muscle and organ mass was increased, sometimes despite the persistence of widespread infections. There are many formulas now available to help restore lean body mass. The better ones have higher than usual amounts of the amino acid glutamine, low levels of fats (triglycerides) and low levels of simple sugars (sucrose, fructose, etc.).

The effects of protein energy malnutrition on the immune system have been documented for years. The Journal of Pediatric Gastroenterology and Nutrition [2(Suppl.1):S181-187, 1983] reported that the lymph system is particularly hard hit in protein deprivation. The lymph nodes and the spleen waste away and the immune tissues associated with the intestinal tract is affected as well. In the gut the chemical Immunoglobulin A (IgA) is responsible for fighting off organisms and preventing their entrance into the blood system. It has been shown that PEM leads to low levels of IgA in the gut and associated loss of protection.

Maintenance of lean body mass is the most important thing to do in any nutritional program. Your lean body mass must be measured on a regular basis. You can lose lean body mass while maintaining your weight by putting on fat. Your lab work should be evaluated for early signs of protein wasting. Regular exercise will increase your appetite and your ability to maintain and gain lean body mass, just ask any body builder!

Regular exercise coupled with the correct nutritional program will serve you well in keeping you healthy.

The purpose of this article is to provide information only and should not be construed as a recommendation of a course of action. Please consult with a qualified health professional before making any decisions regarding your treatment.

Dr. Brian A. Smith is a chiropractic doctor and naturopathic physician who has specialized in the treatment of immune-suppressed individuals since 1987. He is a scientific advisory board member of AIDS ReSEARCH Alliance.

He maintains a private practice in Los Angeles and can be reached at (323) 306-4909. Questions from readers are welcome as are suggestions for future articles. You can also contact him via E-mail at: Send e-mail to Dr. Smith

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Articles by Dr. Brian A. Smith:

HIV and CHIRO † VITAMIN C † BETA-CAROTENE † MINERALS † DMG † PROTEIN † DIET & HIV † MORE ON PROTEIN † NUTRITION † DHEA † LIVER † CHIRO † NAC † SILVER † ALT THERAPIES †