Nutritional Management of AIDS Wasting

By Donna Tinnerello MS, RD, CDN, and Sharon Ann Meyer, AS, AA, DTR

This article highlights information from Charlie Smigelski, RD. This is a continuation of the article which appears in NUTRITION (p.20)

Smigelski started his talk by stating that dietitians are the lifelines for PLWHIV. He referred to the medication side effectsdiarrhea, diabetes, oxidative stress, neuropathy, and lipodystrophyas problems that dietitians can address with their patients.

Oxidative stress is a favorite topic for Smigelski, one that he and many other researchers have been writing about since the beginning of the epidemic. He described nuclear factor kappa B (NF-kappa B), a cellular transcription factor that regulates a wide variety of cellular and viral genes. Nf-kappa B plays an important role in the activation of HIV by modulating hormone around oxidative stress that is the switch for HIV replication.

Studies have shown that HIV-negative people can have three times more glutathione than PLWHIV. Glutathione is the major antioxidant system, whether in the CD4 T-cells, or other systems such as eye lens, red blood cells or lungs. Oxidative stress accelerates the aging process of the body; vitamins C and E help to decrease oxidative stress.1,2 Smigelski discussed a 12-week study which showed a decrease in viral load of 40% with the use of antioxidants. He recommended that all of his patients on failing drug treatment, or no treatment, do something to support their immune system with antioxidants to reduce NF-kappa B activation of virus replication.

Smigelski also talked about gut cell integrity and diet and recommended fruit pulp, oat bran, and flaxseed. He suggested glutamine for diarrhea management3 and for the maintenance of gut integrity and skeletal muscle. Smigelski stated, "If you dont give glutamine, you have catabolism and your body breaks down muscle to make glutamine". With adequate glutamine, diarrhea usually starts to resolve after a couple of days. According to Smigelski "Gut cells make short-chain fatty acids, B vitamins, cysteine, and arginine. You want to keep them healthy". Up to 40 grams per day is suggested to reverse weight loss or to repair the cells of the intestinal tract.4

Smigelski also talked about probiotics. "Dont depend on yogurt to give you the good bugs." Acidophilus from the health food store may not be the solution either. He likes Citrucel better than Metamucil as a bulking agent and a product called Jarrowdophilus (for good bugs) along with glutamine for diarrhea management.

Smigelski addressed the nutritional management of lipodystrophy and described the dyslipidemia of PIs. A big part of the problem might be an essential fatty acid (EFA) deficiency. EFAs include a balance of omega-3 and omega-6 forms. Fish oil supplements without adequate omega-6 lead to a deficiency of gamma linolenic acid (GLA). Smigelski suggests a balance of fish, flaxseed, or fish oil supplements for omega-3 and sunflower seed oil or evening primrose oil (supplements) for omega-6 fats/GLA.

With GLA deficiency, the extra hepatic lipoprotein lipase decreases. This can lead to high triglycerides (TG) and cholesterol levels. GLA deficiency is also implicated in the dry skin (exfoliating dermatitis) of people taking the PI Crixivan. Evening primrose oil improves the skin problem because GLA is responsible for the moisture barrier of your skin.

When using fish oils vitamin E should also be given to prevent oxidative damage.

The diabetes associated with HIV-related lipodystrophy is type-2. According to Smigelski, this is due in part to a GLA deficiency. The body has to convert omega-6 to GLA. In diabetes, the enzyme delta-6 desaturase that is crucial to this reaction is defective. He suggests giving balanced EFAs to diabetics to manage their blood sugars and neuropathy.

Smigelski talked about the problems with the statin drugs for cholesterol management. "They build up in the liver and the result can be a drug induced hepatitis. When you have dyslipidemia the first rule is diet". He discussed hands-on food tips for managing the metabolic abnormalities associated with lipodystrophy and other nutritional issues affecting PLWHIV. His handouts, which are available along with the tape recording of his session, include practical tips and meal plans.

NIAC is planning an all day event for Spring 2001. For further information contact Alan Lee at: <alanleerd@yahoo. com> or at

Charles Smigelski has been working in the field of HIV and nutrition for over 10 years. He has provided nutrition counseling to individuals and groups and has written newsletter articles and nutrition advice pamphlets and he lectures on HIV and nutrition extensively. He is also co-editor of Nutrition for Healthy Living, the Tufts University HIV newsletter, available online at http://www.tufts.edu/med/research/nutrition_HIV/news.htm .

Donna Tinnerello, MS, RD, CDN is an HIV specialist living in New York City. She works at Cabrini Medical Center and is a private consultant and is the Nutrition Editor at Always Your Choice <http://www.alwaysyourchoice. com/nutritional.html>. Contact Donna at <>.

Sharon Ann Meyer, AS, AA, DTR, Certified HIV Counselor, is the President of HIV ReSources, Inc., and Editor-in-Chief of the HIV ReSource Review <http://www.hivresources.com/NewsInfo.htm>. Contact her at <>.