Disclaimer: The following information is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. This article is presented for information purposes, to increase public knowledge of developments in the field of nutrition. No information outlined herein should be adopted without a consultation with your health professional.
Jump Start Your Life With Anabolic PoWeR
By Nelson Vergel, BsChE, MBA, CPT*
Adequate nutrition, supplementation, exercise, rest/relaxation, and hormonal intervention have been demonstrated to be essential elements to increase survival in many critical illnesses (and on healthy subjects, too!). Higher amounts of LBM - Lean Body Mass (not fat) have been correlated to increased survival and slower disease progression in AIDS. But, how does one go about obtaining the needed information to preserve or enhance good health through these elements? Rarely does someone find this information readily available through their physicians. Most physicians have not had sound nutritional education. A study performed by the American Society for Clinical Nutrition in 1991 showed that only 20 percent of medical schools required courses in nutrition, and only one school had a free standing nutritional department. Moreover, some medical doctors only prescribe drugs approved for wasting by the FDA which have only been shown to increase fat content and, as a side effect, also increase female hormone levels in men (rendering them impotent!). Only the most progressive doctors would prescribe drugs for an "off-label" use and tests to determine nutritional status. So it is left to the patient him/herself to "save themselves" by searching for the adequate resources which would expose them to the right expertise areas in wellness and nutrition.
Learning all there is to know to stay healthy can sometimes be overwhelming and seem to be a full-time job. A lot of this information also is common sense and you may have heard it from your grandmother. It took me years to gather information about wellness, nutrition, exercise, and mind/body control techniques. I wish someone had come to me back then with all the information I needed on a silver platter. If I can help it, I do not want people to go through this long process. Although I have been HIV+ for about 13 years, it wasn't until four years ago that I started becoming very symptomatic with thrush, diarrhea, weight loss, sweats, hairy leukoplakia, and skin problems. I became desperate to regain control of my health. It seemed that doctors only were able to treat my symptoms, but nothing was being done to stop the downward spiral in my health. I realized that only I could save myself from what seemed the inevitable. I was also watching as many of my friends were wasting to death and how nothing was being done about it. I guess care takers always assume: "well, he's got AIDS, and that's the way AIDS patients are supposed to look and die". Well, I want to make a statement loud and clear: you do not have to waste away if you have AIDS !!!. I have found that there is a lot of new (and old) information now available to reverse and prevent wasting. This information was the antidote to what ACT-UP has been saying for years: IGNORANCE=DEATH. Fortunately, after applying all the knowledge I gathered, I am glad to say that I am now completely asymptomatic, feeling and looking the best I have in years!!. This program may not be a cure, but it definitely has improved the quality of my life, no matter how many years lie ahead. Yes, it took a lot of dedication and life style changes, but with patience and perseverance it can be accomplished.
Nelson Vergel is the author of a book on this program to combat wasting in critical illness. He has a Bachelors in Chemical Engineering, an M.B.A., and is currently pursuing a Ph.D in Nutrition. He believes that the time has come to start effective prophylaxis against wasting in HIV disease and other chronic diseases. For more information, please call PoWeR - Program for Wellness Restoration at (713) 526-5883 or write to P.O. Box 980741, Houston, TX 77098. PoWeR is a project sponsored by The Larry Garret Foundation, Inc (A 501(c)3 Non-Profit Texas Corporation) and is part of the AIDS Foundation of Houston's Wellness Program. For a copy of the 380 page book on the program, please send a tax deductible donation of $20 ($30 Foreign) to PoWeR at the above address.
As a result of those years of reading, networking, going to seminars, trying different products/techniques and putting all the puzzle pieces together, I created PoWeR - Program for Wellness Restoration to offer this information in a comprehensive way to those that would listen. PoWeR is a state-of-the-art approach to wellness and wasting prevention in HIV disease and other metabolically challenged diseases. The information in PoWeR is disseminated through workshops given nationwide, a 380 page booklet, private consultations, and support groups for those in need of proactive (and reactive) wellness information . I was extremely lucky (although I believe in no coincidences!) to meet and learn from the right experts on the different areas related to wellness. Among some of them are: Dr. Michael Dullnig - from whom I learned much of what I know about wasting reversal; Dr. Mauro Di Pasquale - world expert on the use of anabolic agents and sports nutrition to enhance performance; Dr. Lark Lands - one of the top experts on nutrition in HIV disease; Dr. Luke Bucci - author of nutrition books and avid researcher of the effect of micronutrients in performance and health recovery; Dr. Arlette Pharo - holistic physician who specializes in non-toxic approaches to health and nutritional assessment techniques; and Jaymes Alexander - Bachelors in Kinesiology and experienced personal trainer of people living with HIV, and last but not least, my friend Michael Mooney, who has become extremely committed to helping others to regain or to keep good health. I have contacted some others who are eager to bring their knowledge to the community in Houston. They all believe that an educated patient is an empowered patient who can make informed decisions and question/ customize his care with his/ her health practitioner.
Let's review the main elements of PoWeR:
Understand that you are in control of your health care decisions:
Physicians are trained to treat symptoms, and sometimes they may not be proactive enough to keep you healthy unless you are assertive and aggressive about your choices. You should become his/her partner in your health care. Do not be passive and share the driver's seat in your health care. Keep good records
of your blood work; demand copies of all and ask to be taught on how to read them. AIDS patients fuel a huge multibillion industry. It is only fair that we get optimum health care. A study in the February 1995 AIDS Patient Care found that the monthly estimate spent by patients for the first six months after AIDS diagnosis was $2,764 and patients with advanced AIDS were likely to spend $9,098 on monthly medical costs. So, someone is getting rich treating us. We have to be empowered and informed consumers who demand sound proactive care through, among other avenues, nutritional intervention. We are in the 14th year since this disease was recognized and we still are dealing with basics like lack of good nutritional advise for ALL people living with HIV. Demand that from your physician; he/she is obligated to refer you
to a licensed nutritionist under your insurance. Also, inform yourself by subscribing to newsletters like AIDS Treatment News (415-255-0588), Treatment Issues (GMHC, 132 West 24th ST, N.Y., N.Y. 10011), BETA (1-800-327-9893), and Critical Path AIDS Project (215-545-2212). Also, read books like "Immune Power" by Dr. Jon Kaiser, and "Surviving with AIDS" by Callaway/Whitney and the soon to
be released book: "Positively Well: AIDS as a Chronic, Manageable, Survivable Disease", by Dr. Lark Lands. Information obtained from these sources will keep you current and also give you the tools to hold intelligent discussions with your health care practitioner about your treatment options.
Understand the myths and facts of nutrition in critical illness:
- eating more does not necessarily mean that you are going to gain LBM
- taking a multivitamin with 100% RDA does not necessarily mean your micronutrient needs are covered.
- increasing fat content in diets may increase wasting and diarrhea in some people
- eating well does not necessarily mean you will not need nutritional supplementation
- you may be losing LBM even though your body weight has not changed (fat and extracellular water content compensates for decreases in LBM!)
- sometimes soluble proteins, called cytokines, secreted by white blood cells are the main cause of weight loss when food intake and other factors can not explain it
- exercise (and especially aerobic exercise) can be detrimental for those with high cortisol levels
- nutritional education/intervention should be provided as soon as someone finds out they have a critical illness (not when they are already wasting). Studies held at the University of Miami School of Medicine determined that most HIV+ patients need 6-25 times the RDA on many of the vitamins/anti-oxidants to reach adequate levels in their blood. Also, a Cohort Study conducted for 11 years by researchers at UC Berkeley showed that those taking micronutrients were only 70% as likely to develop full-blown AIDS as those who did not. Nutrition is the one of the last and most neglected frontiers in AIDS. Many AIDS patients do not die of AIDS, but of malnutrition!
Engage in optimal nutrition:
To compensate for the increased Basal Metabolic Rate encountered in illness which tend to deplete LBM, the following recommendations can be considered: (A) eat six small meals a day to keep insulin levels more constant throughout the day; (B) eat protein, carbohydrates, and good fats in every meal; (C) maximize the consumption of whole foods and raw or steamed (washed well) vegetables; (D) ensure a protein intake of 1 gram/lb of bodyweight per day (well cooked chicken, lean beef, eggs, fish, turkey, beans, and protein supplements like an dairy proteins); (E) consume 1 to 1.2 grams/Lb of bodyweight per day of low-glycemic carbohydrates (brown rice, lentils, apples, sweet potatoes, oatmeal, pasta, bananas, whole multi-grain bread, etc); (F) strive to consume mostly good fats (olive oil, canola oil, flaxseed oil, fish oils, borage oil, evening primrose oil, nut oils/butters) and minimize fried foods; (G) keep a caloric intake between 13 and 23 Kcal per pound of bodyweight, per day (depending on age, gender, activity and injury factors); and (H) avoid junk food, alcohol, cigarettes, and recreational drugs. For those with T4 cells under 50, boil your water or buy distilled water since many cities' water supplies are contaminated with Cryptosporidium (a bacteria which could cause chronic diarrhea and for which there is no known effective treatment).
Ensure optimum supplementation to compensate for high oxidative stress in your illness:
Several studies have shown a strong correlation with taking supplements and extended life span. The rapid turnover of HIV and death of T-cells on a daily basis (over a billion T4 cells are destroyed and 50 million virus particles can be replenished every day in AIDS!) can cause increased cytokine (protein messengers in the immune system) and free radical damage of cells. Based on the literature written by Drs. Lands, Bucci, and Kaiser, the following program can be utilized: N-Acetyl-Cysteine (NAC) 500 mg (one-3xday on an empty stomach), vitamin B's multivitamin/mineral (one-3xday with meals), vitamin C-1000 mg (two-3xday with meals), vitamin E 400 I.U. (one-2xday with meals), beta carotene 25,000 I.U. (two-3xday with meals), coenzyme Q-10 30 mg (one-2xday with meals), selenium 200 mcgm (one-2xday with meals), chromium picolinate 200 mg (one-2xday with meals), and essential fatty acids - combination of flaxseed oil, GLA, EPA oils (two-3xday with meals). For those people with limited income, a basic comprehensive packet product like Super Nutrition Opti-Packs will be a good start. Try not to buy these products at retail stores (they make a killing!!). HIV+ buyers clubs that have big discounts on these supplements include:
Wholesale Health (954) 764-1587 (buyer's club in Florida run by HIV+ people)
Houston Buyers Club (Houston) - (713) 520-5288 or (800) 350-2392
Health Food and More (713)-524-2025
D.A.A.I.R. 212-725-6994 (buyers' club in N.Y. run by HIV+ people)
Vitamin Shoppe (800) 223-1216
Puritan's Pride (800) 645-1030.
Another good source of vitamins below cost is joining the HIV supplement/micronutrient study run by Supernutrition Life-Extension Foundation ((415) 641-0212). Call all and get their catalogs. Compare prices and save up to 60% off prices offered by retail stores.
Find out what your nutritional status is:
Most people take supplements and eat a good diet but still do not know whether or not their requirements are being met. As I said before, a high oxidative stress is typical of critical illnesses like HIV disease and cancer. We are all biochemically different. The recommendations presented above are good starting points, but readjustment of dosages/micronutrients are needed after your nutritional status is determined. There are techniques currently used by many physicians to determine your micronutrient/anti-oxidant status, to detect malabsorption problems, and to determine what foods/compounds create an allergic response which burden your immune system. Dr. Arlette Pharo (713- 626-0505) is one of those physicians. She uses SpectraCell's EMA and Spectrox tests, Pantox's anti-oxidant status test, Seraimmune Physicians Elisa/Act allergen tests, Great Smokies Digestive analysis tests, and body composition tests, among others. Dr. Pharo also uses a special software package which includes all factors needed to establish your own personalized nutritional analysis. Ask your physician if he/she knows about these tests. Dr. Pharo is willing to assist your physician if he/she needs more information on how to order kits and how to interpret results.
The only way to increase LBM is to cause muscle hypertrophy (muscle growth) through resistance weight training. Weight training has also been shown to improve people's quality of life and immune response. However, too much or inadequate weight training (overtraining) can be detrimental for LBM and immunity due to the generation of increased amounts of stress hormones (cortisol). Our program recommends sessions of no more than 1 hour, every other day. Intensity has to be at your personal maximum (even if it is only one pound!!). Choosing weights for repetitions to failure (exhaustion) at 10-12 reps will ensure the right intensity to ensure muscle growth. Prior to every work out session, warming up and stretching are needed to ensure no injuries. Do not work out a specific body part if it is sore from previous work outs. Recovery of muscle parts is what makes them grow. Working out with a partner (spotter) is recommended to keep good form and motivation. For those who can afford it, the services of a certified personal trainer can be extremely beneficial to learn the correct form and routines in machines and free weights. Even people who can hardly have the energy or drive to start a work out program can benefit from it. Exercise in combination with proper nutrition, supplementation, and anabolic steroids has been able to reverse wasting in people who have lost over 20% of their original body weight. For those who want to maximize LBM gains, the use of supplements like ion-exchange whey protein, L-glutamine (amino acid), creatine monohydrate, L-carnitine (amino acid), branched chained amino acids (BCAA's), and chromium picolinate have been found to be beneficial in research studies done with athletes.
Start a resistance weight training exercise program:
The only way to increase LBM is to cause muscle hypertrophy (muscle growth) through resistance weight training. Weight training has also been shown to improve people's quality of life and immune response. However, too much or inadequate weight training (overtraining) can be detrimental for LBM and immunity due to the generation of increased amounts of stress hormones (cortisol). Our program recommends sessions of no more than 1 hour, every other day. Intensity has to be at your personal maximum (even if it is only one pound!!). Choosing weights for repetitions to failure (exhaustion) at 10-12 reps will ensure the right intensity to ensure muscle growth. Prior to every work out session, warming up and stretching are needed to ensure no injuries. Do not work out a specific body part if it is sore from previous work outs. Recovery of muscle parts is what makes them grow. Working out with a partner (spotter) is recommended to keep good form and motivation. For those who can afford it, the services of a certified personal trainer can be extremely beneficial to learn the correct form and routines in machines and free weights. Even people who can hardly have the energy or drive to start a work out program can benefit from it. Exercise in combination with proper nutrition, supplementation, and anabolic steroids has been able to reverse wasting in people who have lost over 20% of their original body weight. For those who want to maximize LBM gains, the use of supplements like ion-exchange whey protein, L-glutamine (amino acid), creatine monohydrate, L-carnitine (amino acid), branched chained amino acids (BCAA's), and chromium picolinate have been found to be beneficial in research studies done with athletes. Click here for a great Resistance Exercise Protocol (Routine)
Get hormonal intervention (for those metabolically challenged):
Due to the high Basal Metabolic Rate (BMR), cytokine activation, low energy and caloric intake, endocrinological disturbances, and other factors, some people need the extra help provided by testosterone and anabolic steroids like Deca Durabolin (injectable) and Oxandrin (oral). Anabolic steroids are derivative of the male hormone testosterone. They increase protein utilization for muscle growth (anabolism), increase appetite, stamina, libido, and general sense of well being. Although they are illegal for use for those with no justifiable medical condition, they are perfectly legal by prescription for people with wasting diseases. Many HIV specialists are prescribing them on a weekly or semi-weekly maintenance manner to prevent wasting, or in a 10-16 week "cycling" supraphysiological manner (escalating/descalating dosage regime) for those who have already lost over 10% of their body weight. Anabolics do not work at all without proper nutrition (specifically adequate protein intake), supplementation and weight training. Sitting at home watching TV will not make your LBM grow (although rest is extremely important in any wellness program like this!). More information on anabolic steroid protocols can be found in the next section.
Learn, Labor, Laugh, Let go:
Dr. Barrie Greiff, formerly a psychiatrist at the Harvard Business School, believes that a positive approach to life correlates with health and happiness. He suggests advantageous personal habits or his "Five L's of success": Learn, Labor, Love, Laugh, Let go (which allow you to embrace life with involvement, challenge, empowerment, and fun). Approach each day as a chance to Learn (be open to new experiences), Labor (at something that satisfies you and brings meaning to your life), Love (give, recognize, and receive), Laugh (with yourself and others), and Let go (release things that are out of your control). If you feel alone in your battle, you should know that you are not. Hundreds of people are going through the same awareness experience. Get out and meet them. Join support groups (Body Positive, AFH, Bering Church, Unity Church, Montrose Counseling Center, or any other in your location). Isolation is dangerous to the mind and to your survival.