HIV disease is one of many diseases that expresses itself at some point during its progression by catabolizing the lean body mass, including the muscle tissue. This is partially because the lean muscle mass is the primary reservoir of the amino acid l-glutamine, which is necessary for the function of the t-cells of the immune system.¹ In other words, when the immune system is struggling to fight AIDS-related infections, it pulls l-glutamine from the muscle tissue to keep regenerating the t-cells that are consistently being destroyed in the war with HIV.

I always recommend that HIV+ people practice pre-emptive nutritional practices, and one of the points I emphasize is that protein intake should not just be adequate, but optimal. And during infection, or when there is frank wasting, protein intake should be higher than other times, if at all possible - about one gram of protein per pound of bodyweight is what I recommend.

Interesting data infers that high protein diets may be important for immune function. For instance, one animal study showed that glutathione production generally decreases when protein intake is below 20% of normal calories.² And higher protein intake is known to be necessary for the anabolic effect of anabolic steroids, which are being used effectively for wasting therapy.³ [Of course, if you do eat more protein, drink lots of water. I recommend 6-12 eight ounce glasses/day.

While I have seen health care professionals assert that protein sources are all the same as far as what they contribute to lean muscle gains, the scientific literature shows that some proteins are definitely better than others. Indeed, at a recent natural products trade show one company was pushing their soy protein as being a best protein for building lean body mass. Although the quality of soy proteins has improved considerable in recent years, the trouble with soy or any vegetable protein is that they known to be somewhat less "bioavailable" than animal proteins. Dairy proteins are especially superior, and the best dairy protein fractions contribute significantly more to the accumulation of lean tissue in humans than other proteins including beef and soy. Additionally, soy proteins are generally relatively highly allergenic, and allergenicity increases the potential for diarrhea.

The best proteins at this time are the "undenatured" whey proteins that are on the market in the health food stores and especially one that is being marketed to the HIV community called OPTIMUNE. "Undenatured" means that there is minimal heating or processing of the protein, so the protein retains several natural components that appear to be especially beneficial to PWHIV.

One of the important characteristics of whey is the amino acid balance, which is naturally tilted towards increasing specific anabolic factors in mammal metabolism, like insulin production, via high levels of amino acids, such as the branch chain amino acid, leucine, that is especially insulinogenic.⁴ Dairy proteins even appear to be significantly better (about 50%) for insulinogenesis than the old standard for protein quality, the egg.⁵ But what may be most interesting to the HIV community is the potential that the intact immunoglobulins (IG's) contained in undenatured whey can help reduce pathogens, such as e.coli, and streptococcus a., that harm the intestinal mucosa and cause diarrhea.⁶

While several of the high quality bodybuilding proteins that I have recommended in the past, like NEXT NUTRITION DESIGNER WHEY PROTEIN may contain IG's, one lab test showed that OPTIMUNE contained about 56% more total IG's & more than twice as much of an IG (IGA) that helps control intestinal pathogens than DESIGNER PROTEIN. OPTIMUNE has been shown to stop cryptosporidium in animal tests, although it hasn't performed as consistently in human studies. First studies with humans suggest that OPTIMUNE does help to control diarrhea and improve the health of the intestine so that nutrient absorption increases. Intestinal health is a "missing link" in wasting therapy, and even with all the best food, supplementation, and anabolic steroid therapy available, if intestinal health is radically compromised (eg...non-stop diarrhea), effective wasting therapy will be severely compromised.

Another important point is that a highly undenatured whey will contain intact glutamyl-cysteine molecules that are precursor material for the production of glutathione, the body's most important detoxifying anti-oxidant, and a factor that is known to improve long-term survival.⁷ A new study by Smith (Vanderbilt University.) shows that OPTIMUNE's protein reduced tumor growth, and this points to increased glutathione. The other medical grade protein, IMMUNOCAL, that has been shown to improve glutathione in studies, has been lab tested to contain significantly less IG's than OPTIMUNE, yet it costs 50% more and mixes in water "like chalk", so in the past, I have tended to recommend OPTIMUNE over IMMUNOCAL.

However, I am currently moderating this position, as I have recent personal experience that has rekindled my interested in IMMUNOCAL. One of my close friends is a medical doctor with full-blown AIDS and an extremely high viral load (around 1,000,000 copies). He has had little success with any of the conventional medicines, including the protease inhibitors, so he has stopped using all of them and anabolic steroids too. In his first two weeks of using IMMUNOCAL he has gained about 5 pounds of muscle, and feels better too. This is very impressive when you consider that he had been losing weight and basically has no bodyfat. (My guess is he's at 3 percent bodyfat.)

I await more clinical and anecdotal data on IMMUNOCAL and OPTIMUNE. Please give me feedback if use either of these. OPTIMUNE is available at buyer's clubs - Boston (800-435-5586), Houston (800-350-2392) (Also has IMMUNOCAL), Healing Alternatives (415-626-4053), Phoenix (602-265-2437). Clinicians should call OPTIMUNE for samples - (888) 678-4655.

References:

1. Anon. "Muscle provides glutamine to the immune system." Nutrition Reviews (1990) 48: 390-392, and Ardawi MS et al, "Metabolism in lymphocytes and its importance in the immune response." Essays in Biochemistry (1985) 21 :143
2. Hum S, J Nutri (1992) Oct; 122 (10): 2010-8
3. Freed , Br Med J (1975) 2 (5669) : 471- 3].
4. Floyd JC, et al., J Clin Invest (1966) 45:1487
5. Nuttall PA, Metabol. (1990) July 39.7:749-55
6. Rump JA, et al., Clin Invest (1992) 70:588-594
7. Herzenberg L, Pro Nat Acad Sci (1997) Mar 5