Wellness Education

PoWeRful Nutrition

by

There is so much confusing and contradictory information out there about healthy eating. I will try to summarize what I have learned as a bodybuilder who wants to stay healthy as I age. The choices of foods that we can now can have a significant effect not only on our body shape and quality of life, but also mortality and on how well we age.

The components of whole food. Foods are made up of many different components—some are “micro” or smaller quantity nutrients, like vitamins, and some are “macro” or larger quantity nutrients. The three macro groups that compose the majority of our diets are carbohydrates, proteins, and fats. These three units are the basic materials that fuel our activities and metabolism and maintain body composition. Selecting the best sources and amounts of these three macronutrients may help to minimize metabolic disorders (such as high cholesterol and blood sugar) and prevent loss of lean body mass and accumulation of body fat.

The best carbohydrates.

Carbohydrates provide our body’s main source of quick energy. After carbohydrates are digested and after some processing by the liver, they are released into the bloodstream as a sugar called glucose to be delivered to the cells.

Throughout the majority of the last million years of our evolution, the human diet consisted of animal carcasses, some seeds, nuts, and fibrous vegetable and fruit carbohydrate sources that are generally nutrient-rich with lots of water, but are not calorie-dense like processed foods of today. The majority of these carbohydrate sources are vegetables, leaves, roots, and fruits (all rich in fiber). Because vegetable fiber tends to slow down digestion, a majority of the carbohydrates in these foods are absorbed relatively slowly, inducing less blood sugar (glucose) and insulin spikes than processed sweets that contain no fiber. Some people call these “slow carbs.”

It was only after the advent of agriculture that human beings were introduced to higher intakes of grains as carbohydrate sources. Higher intakes of grains deliver lots of calories. Additionally, some grains deliver their sugar energy relatively quickly, especially if the grain is milled (which removes the fiber that slows down sugar absorption), as are the grains in breads and pasta. Unless you are very active and exercise enough to metabolize nutrients more rapidly, this quick glucose release into the bloodstream can create a dysfunctional hormonal environment that can ultimately promote obesity, cardiovascular disease, and diabetes. This hormonal shift also has a profound effect on lean body mass and fat metabolism, and possibly immune function. The key hormone involved in this problem is called insulin, produced by an organ called the pancreas.

Insulin and insulin resistance.

The hormone insulin is produced by the pancreas to control blood sugar and store it in muscles for later use as glycogen. Insulin’s main job in the body is to promote the delivery of sugar energy as glucose to cells. When a small amount of glucose is delivered into the bloodstream, a small amount of insulin is produced by the pancreas to accompany it. When there is a large amount of glucose, the pancreas works to produce a large amount of insulin to facilitate its delivery so that cells can take in as much glucose as possible. Extra glucose that cannot be taken in by the cells circulates in the bloodstream and can be toxic to brain cells, so under normal circumstances, most of it is soon converted into triglycerides (fat) in the liver to be stored for later use. But we have to be careful with high blood levels of triglycerides, since they are what feed fat cells.

The correct amount of carbohydrate sources will provide enough sugar to give a healthy amount of glucose to the cells, but not too much at once. Thus, levels of glucose and insulin in the bloodstream are not unusually elevated for any long period of time. The pancreas works, but it is not overworked trying to keep up with an unusual demand for insulin. However, in the U.S., much of the diet consists not only of large amounts of high-calorie carbohydrate sources, but also of carbohydrates from sweets and sodas, which are very concentrated sources of sugar. The net effect that intake of these calorie-dense carbohydrate foods creates is a bloodstream that is occasionally flooded with large amounts of glucose, a pancreas that is overworked, and large amounts of insulin and triglycerides circulating in the bloodstream. Note that excess insulin causes increased production of cholesterol.

Over time, these occasional glucose, triglyceride, and insulin floods can cause a decrease in the sensitivity of the cells’ response to insulin, which reduces the cells’ ability to take in glucose. Insensitivity to insulin is called insulin resistance, and it is a serious consideration in metabolic problems. Some HIV medications can worsen insulin resistance, so we need to be aware of nutritional considerations that can help. Ways to decrease insulin resistance are to exercise, follow a proper diet, and taking medications that improve insulin response. For instance, several studies have found that people consuming an overall high-quality diet, rich in fiber and adequate in energy and protein, were less likely to gain fat. This is why it is best to select the majority of your carbohydrate intake from fiber-rich, slow-releasing carbohydrate sources that do not contain an excessive amount of calories. And these good carbs should be accompanied by good sources of protein and fats.

Combining carbohydrates with protein, fiber, and fat. Protein, fiber, or fat will slow the absorption into the blood of glucose from carbohydrates, which helps to reduce the rise in blood sugar and insulin spikes. So, mixing carbohydrates with protein, fiber, and good fats is one way to reduce their problematic effect on blood sugar and insulin. Ensure that every meal and snack you consume has a mix of these three macronutrients. But what are the best fats, protein, and high-fiber carbohydrates sources out there?

Fats and oils.

There are a number of different kinds of fats. There is motor oil, there is butter, and there are essential fatty acids. The most important oil to keep a Honda running right is not the kind with essential fatty acids (EFAs), but if you want to help your body stay healthy and your immune system operating at its best, you had better consider getting these EFAs on a daily basis. They are called “essential” because your body cannot manufacture them, and must obtain them from an outside source, like food or supplements. These oils are necessary for every critical function in your metabolism, including building lean body mass and fighting infections.

The main point is that since we need EFAs and other fats for health, we should be getting them in our diets from fresh, high-quality sources. A proper diet reduces the amount of starchy carbohydrates while maintaining a certain amount of healthy fats so that there is a different macronutrient balance than the old high-carbohydrate, high-protein, low-fat diets contained. This means striving to get fatty acids from several sources, the least of which are the saturated fats in butter or animal fat. Understand that saturated fats are not the demons we have been led to believe. When we realize that we evolved getting a certain amount of saturated fat from foods in the wild, it is only logical that they would have a place in a healthy diet. One recent study showed that dietary saturated fat and mono-unsaturated fat were associated with healthy testosterone production in humans, while EFAs had no effect. So it appears that we need a little saturated fat for optimal hormonal health. However, most people get far too much saturated fat, which promotes insulin resistance and metabolic problems, and not enough EFAs, which are needed for healthy cells and immune function.

The other important kind of fat that we should consciously include in our daily diet is mono-unsaturated fat, which we get from foods like olive oil. Recent data have shown that mono-unsaturated fats decrease the risk of certain cancers, and have an anti-inflammatory effect.

Fatty acid recommendations.

EFAs include the omega-3 and omega-6 fatty acids. Most people get an imbalance of these two by consuming too small an amount of omega-3 fats, which have anti-inflammatory properties, and relatively too large an amount of omega-6 fats, which tend to promote inflammation when out of balance. To get more omega-3s, eat more fish, including salmon, tuna, sardines, anchovies, mackerel, rainbow trout, and herring. Omega-6s are contained in common vegetable oils, like sunflower, safflower, and corn oils. Try to reduce your intake of these.

Oils and cooking.

Olive oil is one of the best oils to cook with. You can also cook with high-oleic sunflower oil, avocado, canola, macadamia, or any oil that is high in mono-unsaturated fatty acids.

Avoid cooking with oils made from corn and sesame. These oils contain more omega-6 fats, and less mono-unsaturated fats, so they have a higher potential for spoiling and turning to trans-fats, which are bad for the immune system. Try to avoid any intake of these oils when they are not absolutely fresh.

Also, choose oils that are minimally processed. Most of the clear oils in supermarkets are stripped of some of their natural components to make them more suitable for sitting on store shelves for long periods of time without spoiling. Do not use these stripped oils. When you do cook, do not overheat the oil so that it smokes, which causes the formation of carcinogens and destroys the beneficial fatty acids.

Avoid margarine, hydrogenated fats, or processed oils.

Do your best to avoid processed fats or oils, as they have negative effects on cellular health, overall metabolism, and your immune system. Look out for the words hydrogenated and partially-hydrogenated. These kinds of manipulated fats probably do increase the risk of cancer and heart disease. They also weaken healthy cellular immune metabolism. Lastly, they are also likely to promote high lipid levels and insulin resistance.

Protein, food for the immune system.

Dairy protein fractions, such as caseine (contained in milk curd) and whey, are at the top of the list of proteins that optimally feed lean body mass growth. In dairy products, the amino acid balances, insulin-raising potential, and overall growth factor content add up to one thing: milk proteins were created to make mammals grow bigger. While there is a lot of hoopla related to which dairy protein fractions are best, there is more misinformation than reality in this area. Those with lactose intolerance should be careful in their selection of milk-based products. Aged cheeses and yogurt may be more tolerable for those who cannot digest lactose.

Egg protein.

Next on the list are egg proteins. The important thing to remember is that whole egg is probably somewhat better than egg white for lean body mass growth and overall health effect, because the yolk is a rich nutrient source, and its protein content complements the protein in the egg white. Together they are a better source of protein.

Meat protein.

While real food like meat often seems to take a back seat to protein powders because of a mindset created by slick advertising, professional athletes know the value of real food related to lean body mass growth. If you do not make real food and meat fundamentals in your diet, you will not grow lean body mass tissue as well. Fish, chicken, turkey, and beef are vitally important foods, not only because of their protein content, but because they contain numerous other nutritional components that are important for a healthy metabolism. The message is: eat real food, then supplement food with protein powder drinks if you need them.

Lean red meat is a superior source for lean body mass growth and blood-building nutrients. These include creatine, carnitine, phenylalanine, conjugated linoleic acid (CLA), and heme- (blood) iron, the most absorbable form of iron. And meat, in general, is less likely to cause allergic reactions than eggs or dairy proteins, like casein and whey. The only caution about red meat is that the high amount of saturated fat most commercial red meat contains could promote metabolic problems. So be moderate about including it in your diet and choose leaner meats if you do.

Important details on meat: cooking kills bacteria in meats. Stewed meat is better for digestion (chicken soup, beef stew). Roasting is okay. Try not to fry or barbecue with charcoal. Charred foods are associated with increased risk of gastrointestinal system cancers. Any cooking of meat or vegetable protein that causes the formation of a hard outer skin renders the protein that becomes the skin to be much less digestible because it cross-links the protein.

Vegetarian diets

It is very difficult to gain lean muscle weight on a vegetarian diet. In fact, it is almost impossible for most people, especially when they are fighting infections that burn lean body.

If you do choose a vegetarian diet, your best protein sources are beans, seeds and nuts. Digestion of nuts and seeds will be improved by soaking them overnight to reduce the enzymes they contain that inhibit digestion of proteins. If you can eat them without digestive problems, many nuts and seeds are ideal foods because they contain protein, healthy fat, and complex carbohydrates in a very good balance for overall health. They also make a great snack between meals. However, the amino acid balances in these proteins do not appear to be optimum for lean body mass growth for humans.

Calcium and vitamin D—two important micronutrients

We know that calcium and vitamin D help to strengthen bone. Many of us chose to take calcium plus vitamin D supplements, but there are also foods that are rich in these nutrients. Calcium-rich foods include milk, cheese, spinach, fortified orange juice (be careful with the sugar, though!), fish, eggs, and beans. Vitamin D-rich foods include milk, most fish, and eggs. However, most of us do not consume the 1000 mg and 2000 IU needed per day for calcium and vitamin D, respectively, and need to take over-the-counter supplements.

Miscellaneous nutrition tips

  • Shop mostly in the outer part of the grocery store where the fresh produce, meats, and milk products/eggs are. Avoid overly processed canned or packaged foods, except for frozen vegetables. Read the labels and avoid products with many preservatives and additives. Trans-fats and hydrogenated oils, high fructose corn syrup, and high sugar should be on your radar when reading labels.
  • Try to eat several smaller balanced (protein + good carbs + good fats) meals or snacks instead of two to three large ones. Smaller meals/snacks are more easily digestible, keep blood sugar and insulin more constant through the day, and keep you from binge eating late at night.
  • Eat more almonds, walnuts, pecans and pistachios (good cholesterol-lowering fats). Twice a day, snack on such nuts to get your good fats and fiber. If you wish, mix them with some dried fruit. Research has shown that people who eat nuts tend to have lower LDL cholesterol.
  • Avoid junk and fast food. The best way to do this is to have enough food at home and to bring lunch to work. Cook a lot of food on weekends and freeze meals in small containers you can heat up later.
  • Do not sabotage yourself by bringing sweets and junk into your home. Watch your cravings at night, when most people find it the most difficult to avoid overdrinking alcohol or eating ice cream, cookies, and comfort foods.
  • Eat a large breakfast, a moderate lunch, and a small dinner. Skipping breakfast makes you more prone to overcompensate by eating more calories late in the day. Your body has spent several hours without food and is starved for nutrients in the morning. Do not feed it sugar and white flour products at this important time. Eggs, oatmeal (the type that has no added sugar, and you can add whey protein powder to it!), Greek-style yogurt with nuts and fiber supplements, low-fat cottage cheese with fruit, almond butter on multigrain (high-fiber) bread, and fruit are all good choices for breakfast.
  • For lunch have some soup and a glass of water first and wait 10 minutes to trick your body into feeling full faster. Grilled chicken with vegetables, tuna salad over greens and nuts, a Greek salad with sliced steak, and any Mediterranean food choices are good.
  • For dinner, fill yourself with stir-fried (use olive oil!) vegetables and lean meats. Two hours before bed, you can have half an almond butter sandwich or yogurt with fruit. You will not be hungry and desperate with this diet!
  • Eat fruits and vegetables of all colors. Each has a different antioxidant profile. The produce section of the market is basically a fresh vitamin department and a medicine chest. Some foods like garlic, onions, and ginger have genuine therapeutic effects. Eating the widest variety of fresh produce on a daily basis assures you of getting all the ingredients that nature provides that can help keep your body strong enough to handle bacteria and viruses so that you stay healthy.
  • Avoid sodas, sweet drinks, and fruit juices (fruit sounds healthy, but juice contains too much sugar and no fiber to slow down its absorption into the blood). Consuming sugar daily can affect your metabolism, create insulin resistance, make you fat, and have all kinds of negative health consequences. The suggested pecking order of carbohydrate food sources that support your health without increasing insulin resistance follows. Best are vegetables in their many forms. Next are beans and peas. These deliver more calories than vegetables, but the carbohydrates release much more slowly than grains. Next are whole grains, which are calorie-dense but contain carbohydrates that, in general, release somewhat slowly. At the bottom, and the most likely to promote body fat problems, are carbohydrates from milled grains, like wheat and corn. Whole grains are marginally better than processed grains, but when they are milled into flour the difference is not that great. The very worst carbohydrate sources are sweets, like candies, which can deliver as many as 2,000 calories per pound. Try to eat from the first group of slow-release carbohydrate sources most of the time, and if you are relatively healthy, you can have small amounts of milled wheat products or sweets once in awhile.
  • Drink lots of water. Six to eight glasses a day is a good goal. If you get thirsty, you are already dehydrated!
  • Eat a high-protein, complex carbohydrate-rich meal after workouts. Examples: chicken salad with nuts, cottage cheese or yogurt and nuts/fruit, celery sticks and hummus (chickpea butter), etc.
  • Manage your intake of caffeine (it reduces appetite but can increase anxiety). Do not have any caffeine after 4 p.m., since it can impair your sleep.
  • Minimize hidden sugars like high fructose corn syrup. Read the labels of food you buy. Diet sodas tend to make your brain crave sweets in general, so they are not good substitutes for sugary drinks. Water, water, water!
  • If you do not consume at least 20 grams of fiber a day, add to your intake supplements like Citrucell or Benefiber, purchased in any grocery store. Fiber improves insulin sensitivity, makes you feel full longer, keeps your gut healthy (friendly gut bacteria that produce vitamins love fiber), keeps you regular and reduces diarrhea, and can lower the chances of getting colon cancer.
  • Eating healthy is eating smart, and it does not mean that you should starve yourself. Hopefully, this information has shed some light on healthy food sources and how they can affect health and the body. So, take charge of your health and take care of your body. It is the only one you have.

Healthy Eating Shopping List

    1. Produce
  • Spinach and other green leafy vegetables
  • Broccoli and cabbage
  • Green beans
  • Avocados
  • Raspberries and all berries. You can buy frozen ones and add to whey protein shakes
  • Whole fruits (remember no juices).
  • Sweet potatoes, carrots
  • Hummus
  • Beans and other legumes (you can buy canned or frozen ones)

    2. Nuts, Grains, Oil
  • Mix of almonds and other nuts
  • Peanut, almond, and cashew butters without hydrogenated oil (the healthy nut butters show oil and butter separated since the lack of hydrogenated oils prevents emulsification)
  • Pumpkin and sunflower seeds
  • Wild rice (the darker the rice, the better)
  • Whole grain breads and pasta
  • High fiber crackers
  • Oatmeal (not the little packets; those are loaded with sugars)
  • Olive oil

    3. Dairy
  • Low fat milk, cheese
  • Yogurt (Greek style, no sugar added)
  • Eggs (free range or Omega 3 enriched if possible)

    4. Meat
  • Lean meats
  • Salmon, sardines and tuna
  • Occasional glass of red wine per day (optional)

    5. Supplements
  • Whey protein (I like the Isopure brand since it does not give me gut problems and it is very light) (50-100 grams per day in 2 servings)
  • Vitamin D (2000-6000 IU per day based on blood levels)
  • A multivitamin (Super Nutrition’s Super Blend) (one with breakfast and one with dinner)
  • Fish Oils (2000-3000 mg per day)
  • Coenzyme Q-10 (100-300 mg per day)

For More Tips:
BUILT TO SURVIVE (free PDF)
A Comprehensive Guide to the Medical Use of Anabolic Therapies, Nutrition and Exercise for HIV (+) Men and Women

OTHER BOOKS BY NELSON VERGEL, Et AL
BOOKS ON AMAZON
  • Testosterone: A Man's Guide- Second Edition
  • La Testosterona: La Mejor Guia Para Hombres (Spanish Edition)
  • Built to Survive: A Comprehensive Guide to the Medical Use of Anabolic Therapies, Nutrition and Exercise for HIV+ Men and Women
  • Built To Survive: HIV Wellness Guide Fourth Edition
  • What You Need to Know About Your Man's Testosterone
  • Fortalecete y Sobrevive el VIH (Spanish Edition)

Exercise: The Best Therapy for Managing Side Effects

How to Stay Active and Energetic

By Michael Mooney and Nelson Vergel

There are many benefits of exercise in HIV disease. Besides the evident improved self-image, energy level, and mental outlook, several research studies performed with HIV-positive people have found the following clinical benefits in body composition and metabolism.

Exercise produces improved muscle function, increased body dimensions and mass, and strength when used alone.1,2 It may reduce trunk (belly) fat mass in patients with HIVlipodystrophy.3 It increases muscle mass and decreases LDL (bad cholesterol) when combined with testosterone in eugonadal men (men with normal testosterone) with wasting.4

It increases build-up of lean tissue and strength gain when combined with oxandrolone (Oxandrin, an oral anabolic) in eugonadal men with wasting.5 Muscle hypertrophy (enlargement), induced by resistance training, may decrease triglyceride levels in the blood of hypertriglyceridemic (those with high triglycerides), HIV-positive men being treated with antiviral therapy.6

Acute exercise does not have a deleterious effect on HIV replication in adults with high viral loads.7 Moderate physical activity may slow HIV disease progression.8 Exercise is associated with significant improvement in mood and overall distress, as well as a significant increase in body cell and lean body mass.9

Exercise can increase bone density in men and women.10 Testosterone and resistance exercise promote gains in body weight, muscle mass, muscle strength, and lean body mass in HIV-positive men experiencing weight loss and low testosterone levels.11

Exercise training resulted in a substantial improvement in aerobic function while immune indices were essentially unchanged. Quality of life markers improved significantly with exercise.12

Getting Started

Before you start an exercise program, there are some things to consider. First, get your blood pressure, heart rate, weight, body dimensions, fasting cholesterol, triglycerides, and blood sugar measured. Your doctor should be able to advise you if you are capable of exercising without health if you can.

If you feel tired and weak, start walking every day to your best ability. Walking can help increase energy levels to enable you to start a more intensive exercise program later on when you're feeling better. Using a cheap pedometer to measure your daily steps is useful. Try to reach 10,000 steps a day since that has been associated with good cardiovascular health and fat loss.

There are two types of exercise: resistance (or weight) training and cardiovascular (or aerobic) exercise. Resistance training uses weights to induce muscle growth. Cardiovascular exercise improves the way your body uses oxygen and increases metabolism so that you can burn fat and lower bad cholesterol and blood sugar.

Do low-impact aerobic exercise three to four times a week. Exercising for 20-40 minutes by walking fast, bike riding, going up the stairs, using a stationary bike, elliptical trainer, or treadmill will increase your aerobic capacity, help to burn fat, and decrease cholesterol, triglycerides, and blood sugar. Jogging should only be an option if you have very strong joints and no problems with neuropathy. Do not do aerobic exercise if you are losing weight involuntarily or if you are tired or recovering from illness. Some people worry that cardiovascular (aerobic) exercise can increase fat wasting (lipoatrophy), but this fear is unfounded, in our opinion.

Recommendations

Train with weights and machines three times a week for one hour. Starting with machines is the safest way until you get familiar with the exercises. As you feel more confident and strong, bring in free weight exercise (hopefully with the help of a workout buddy). As you get stronger, increase your weights in every exercise. Exercise one body part per week, and do three exercises per body part. One light warm-up set and two heavier sets of eight to ten repetitions (to momentary muscular failure, meaning until you can not do another rep) are enough for each exercise. If you do not have access to a gym, do push ups on the floor and squats holding books or large bottles full of water at home. As long as you are "resisting" your own body weight, you are doing resistance exercise. You can also get an exercise ball and follow this great home-based workout:

www.myfit.ca/exercisedatabase/search.asp?muscle=Home&equipment=yes.

For examples of other exercises you can do at home, visit

http://weboflife.nasa.gov/exerciseandaging/chapter4_strength.html.

For great resistance exercises at the gym,visit:

www.myfit.ca/exercisedatabase/weight_lifting_exercises.asp.

Important Things to Remember

  • Learn how to do each exercise correctly and concentrate on using strict form to get the most out of exercise and prevent injuries.
  • Make sure your muscles are warm before targeting them with more challenging weights. Warm them up with a light, high-repetition exercise set.
  • Don't use your body to add momentum; cheating this way takes work away from the targeted muscles. Use a deliberate speed to increase the effectiveness of the movement.
  • Use a full range of motion on all exercises. Feel the muscle stretch at the bottom and go for a momentary peak contraction at the top. Don't go too fast!
  • Warm up before you work out and stretch afterwards to prevent injury. Briefly stretch the major muscle groups before your training. Th is helps flexibility and muscle recovery. For stretching routines, go to http://weboflife.nasa.gov/exerciseandaging/chapter4_stretching.html.
  • Feel the muscles working by keeping your head in what you're doing. Focus on your muscles contracting and relaxing. Concentrate on your body exercising, not on thoughts or people around you.
  • If the weight's too light (more than 12 repetitions), try using a heavier one with more resistance or do the movement more slowly and really feel the contraction. You should be barely able to finish the tenth rep if your weight is the right one. Of course, as you get stronger with time, increase your weights.
  • Keep rest periods to no more than about 20-30 seconds, or shorter, depending on how tired you are from your last set. This will also help to give your heart a mini-workout.

Safety First

Always remember -- safety first! If something you do in an exercise hurts, stop! Ask for help to figure out what you're doing wrong. Maybe it's improper form. If you hurt yourself, you will hinder your progress because you won't want to work out! Learn proper form! Do not exercise if you feel you are coming down with a cold.

Commit Yourself

If you can afford it, join a gym. If you spend the money, you'll be more likely to stay with it, and consistency is the key to success in any exercise program. Also, try to find someone who is enthusiastic to train with, or get a personal trainer (if you can afford one). It's easier to stay motivated when you train with someone else who has a vital interest in your mutual success. It's also safer to have someone to spot you when you lift heavy weight.

Avoid Overtraining

Working out for more than an hour can cause overtraining that can destroy your muscles, decreasing your strength. Overtraining is probably the factor most ignored by exercise enthusiasts. In order to build muscle, the body has to receive a stimulus, a reason, to grow bigger, or hypertrophy. It's really very simple: the body only does what it needs to do, what it is required to do. It isn't going to suddenly expand its muscle mass because it anticipates needing more muscles. But if it is challenged to move weights around, it will respond by growing.

Another way to look at it is, if you take any body builder and put him in bed for weeks at a time, he'll begin to rapidly lose muscle mass because the body will sense that it doesn't need the extra muscle any more. So, one needs to deliver the stimulus to begin muscular hypertrophy (growth) and that's what lifting weights does. However, overdoing exercise stresses out the body and initiates the process of actually breaking down muscle mass as the body begins to burn its own muscles to use for fuel. This is why so many people don't grow at a satisfying rate. Even worse, often times these people will think they aren't training hard enough, and increase their exercise routines, thinking they just need more stimuli! And this is where the biggest error is made -- more is not necessarily better! It seems paradoxical that you could work out less and growmore, but this is very often the case.

Therefore, any exercise beyond that which is the exact amount of stimulus necessary to induce optimal muscle growth is called overtraining.

A Workout Log Is Recommended

The best reason to keep track of your workouts is so you can see graphically what you are accomplishing, and analyze your pattern to see if you're overtraining. You will also be able to see whether you're gaining strength at a reasonable rate. You will find when you log your workouts, that if you are overtraining, you won't be gaining in strength or muscle size.

So document your workouts by keeping track of the weight you lift and the amount of reps you lift for each exercise, and then when you go in to train again the next week, you'll know what you are trying to improve upon. If you find out that you're weaker than you were the time before, and everything else like nutrition, etc. is in line, you may be training too often. For downloading workout logs, visit www.exrx.net/WeightTraining/WorkoutLogs.html.

Food and Hydration

Drink at least eight glasses of water a day to keep hydrated. Dehydration can rob you of energy for your workouts. Drink plenty of water while working out and avoid sugary drinks, since they will cause fatigueafter an initial burst of energy. Some people like to drink green tea or creatine in juice before a workout to help increase energy levels through a workout. A light carbohydrate meal (fruits, carbohydrate drinks, etc.) before a workout and a protein-rich one afterwards is advisable. Keep yourself well hydrated with plenty of water throughout the workout. And get plenty of rest afterwards.

Do not work out after eating a regular meal. Wait at least two hours. If you need a snack, have some fruit and a slice of toast with peanut butter one hour or more before working out. Do not consume protein shakes before working out (leave them for after the workout). Digestion will slow down your workouts and bring your energy down. Within 30-60 minutes after the workout, feed your muscles with a balanced meal containing protein, good fats (olive oil, flaxseed oil), and complex carbohydrates, like fruits and whole grains.

Supplements like glutamine, creatine, and whey protein may be a good thing to consider. A shake containing one heaping tablespoon of glutamine, two tablespoons of flaxseed oil, one or two scoops of whey protein, fruit, and milk (if you are not lactose intolerant, otherwise almond or rice milk, though not soy, since it has been shown to increase estrogen in both men and women), provides a good balanced meal after a workout.

Resources

Two of the best websites for video clips of exercises and an explanation of anatomy are:www.exrx.net/Lists/Directory.html and www.myfit.ca.

The Clinical Use of Anabolic Steroids in HIV: A Practical Guide

Summer 1998

For those who need to regain their lost lean body mass (LBM), anabolic steroids are a possible answer. These compounds are being prescribed increasingly by some physicians to treat their HIV-infected patients. Androgenic/anabolic steroids are synthetic analogs of the natural androgenic "male" hormone called testosterone that is produced primarily in the testes in males and in the ovaries in females. Many of them were originally synthesized in the 1930's and 40's in an effort to deliver a more optimal protein tissue building (anabolic) effect with less of the potential for masculinizing (androgenic) side-effects that are characteristic of testosterone itself. Although they are not part of the "standard of care" for HIV disease, anabolic steroids have gained acceptance in reversing the loss of LBM, strength, sexual function, appetite, and general sense of well being in HIV positive patients. However, they have received a lot of bad press due to their abuse in the bodybuilding and sports world and were banned for general public use with the Anabolic Steroid Control Act enacted by the U.S. Government in 1990. This act made anabolic steroids Class III regulated drugs, available by prescription only to people with justifiable health problems. All anabolic steroids but one have been approved to treat anemia related to renal insufficiency and other non-wasting related disorders. So physicians who prescribe these compounds to treat LBM loss are doing so under an "off-label," yet legal, application.

Women and Children Often Forgotten

Women and children are often ignored when it comes to wasting. Physicians may be afraid to prescribe anabolics to women because of the potential to masculinize them. Women also have the added pressure from society (and sometimes their physicians) to be thin, so wasting may go unreported and untreated in this population. Most anabolics will stunt growth in children (children with HIV also have slow growth problems). Some anabolics agents like human growth hormone (Serostim™), and the oral anabolic steroid oxandrolone (Oxandrin™) appear to be safe and effective for women and children with HIV. However, they are both very expensive, so many HIV-positive people have to turn to pharmaceutical compassionate use programs, which can be difficult to access. Furthermore, no State AIDS Drug Assistance Program (ADAP) includes these compounds in their list of approved drugs for those who are uninsured.

How do Anabolics Work?

The anabolic effect of anabolic steroids is elicited by the action of the steroid on androgen receptors in muscle tissue. The steroid binds to the receptor and is carried to the nucleus of the cell where it instructs the cell to increase protein synthesis. This results in hypertrophy (growth) of the cells and the muscle tissue itself.

The different molecular configurations of the various anabolic steroids cause significantly different responses, and even a subtle change of one atom can elicit a unique response for a specific steroid.

Potential Side-Effects

Testosterone, being the most androgenic of all compounds soon to be discussed, is responsible for most of the side effects cited in the literature. Long term use of moderate to high doses (greater than 200 mg/week) may cause side effects which can include acne in the back and shoulders, hair loss, testicular atrophy (reduced size of testicles), mood changes, prostate enlargement, facial hair growth in women, and water retention. Other anabolic compounds are more benign than testosterone and still very effective in their anabolic action.

Oral steroids may cause liver toxicity which manifests as increases in liver function tests in the blood. Dr. Patricia Salvatofrom Houston has found that common injectable steroids have not caused this kind of liver burden in over 200 of her patients using anabolic steroids. Some people prefer injectables to oral steroids for this reason. Injectable steroids, however, may appear to cause elevated liver function tests during increased exercise and other stress in the body. Liver test elevations usually reverse with cessation of the steroids.

Injectable Anabolic Steroids

Testosterone

Testosterone is the primary androgenic/anabolic hormone in the body of men and women. The forms of injectable testosterone available in the U.S. are testosterone cypionate and testosterone enanthate, both of which maintain blood levels of testosterone for a number of days. Without the cypionate or enanthate "carriers," testosterone is cycled through the body in several hours, so these carriers are important for ease of use, as they allow weekly rather than several times per day administrations. Both products come in a 10-ml bottle with 200 mg/ml. Many physicians prescribe anywhere from 200 mg/every other week to 100 mg/week.

The first controlled study on high dose testosterone enanthate with normal HIV negative men was published in the New England Journal of Medicine on July 4, 1996. This study involved the use of 600 mg per week of testosterone enanthate for ten weeks, and was controlled for weight training. Four different combinations were evaluated; testosterone with exercise, testosterone without exercise, exercise without testosterone and no exercise with no testosterone. Those who were given testosterone plus exercise had the greatest increase in muscle strength and greater increases in body weight compared to the other groups.

Nandrolone Decanoate(Deca Durabolin™)

Nandrolone decanoate is felt to be one of the best anabolic steroids for men because it has much less potential for side effects than testosterone, yet it still has basically as much or more anabolic potential as testosterone. The decanoate> "carrier" delivers nandrolone over a slightly longer period of time than a cypionate carrier, but weekly injections are still preferred. The package insert administration recommendations of the manufacturers of nandrolone decanoate have recently been changed from bi-weekly injections to weekly injections. Keep in mind that nandrolone decanoate is the generic version of Deca Durabolin™ and can be purchased for about one third the cost per vial.

Nandrolone does not produce as much androgenic activity in the body as testosterone, so there is considerably less potential for hair loss or prostatitis (inflammation of the prostate).

Nandrolone does not produce as much androgenic activity in the body as testosterone, so there is considerably less potential for hair loss or prostatitis (inflammation of the prostate).

Dr. Julian Gold in Australia published two studies in 1996 and 1997 showing that 100 mg of nandrolone decanoate produced significant increases in lean body mass and quality of life for HIV positive male patients.

At the XI International Conference on AIDS, in July 1996, Dr. Gary Bucher of Chicago's Center for Special Immunology, presented the first placebo controlled study of the anabolic steroid nandrolone decanoate with 73 HIV patients over 12 weeks. There was a significant increase in lean body mass, even though there was no specific weight training protocol, and we know that steroids exert their greatest effect on gaining LBM when weight training is performed. Hematocrit increased significantly.

There are several points that should be noted. First, the dosage used in this study is rather low at 100 mg of nandrolone decanoate per week. For instance, a study underway at University of Southern California at Los Angeles that was being directed by Dr. Fred Sattler, is using 600 milligrams of nandrolone per week. This higher dose is being studied because there is good reason to believe that it will be much more effective for increasing lean body mass yet still be safe . There are several other studies in progress using these higher dose.

Oral Anabolic Steroids

Stanozolol(Winstrol™)

A study that reviewed patient charts of HIV-positive men given stanozolol showed that it may be valuable for lean body mass improvement at doses of only 6-12 mg per day. stanozolol is priced much lower than oxandrolone at about $80 per 100 two-milligram tablets. So, this makes it much more accessible than oxandrolone, which costs about $300 per 100 2.5 milligram tablets. Stanozolol is an unusual compound that is considered to be relatively free from side effects, even for women, because like oxandrolone, it has a very low androgenic potential. While the previously mentioned study on HIV-positive men using stanozolol showed significant bodyweight improvements from doses as low as 6 and 12 milligrams per day, anecdotal information suggests that stanozolol exerts its greatest effects when combined with anabolic steroids like nandrolone or testosterone. An appropriate dose for stanozolol used in combination with either nandrolone or testosterone appears to be between 6-18 mg/per day for men, and 4-12 mg per day for women. Stanozolol, for unknown reasons, also appears to have a positive effect on libido, and much more so than oxandrolone. Watch for liver enzyme increases if taking protease inhibitors and stanozolol.

Oxandrolone(Oxandrin™)

Unlike all the other anabolic steroids, oxandrolone is an oral steroid specifically approved for the treatment of weight loss due to trauma, sepsis, surgery, and other conditions. Oxandrolone is also very mild and, according to the manufacturer, not liver toxic. However, there have been reports of people on ritonavir or other protease inhibitors who have experienced increases in their liver enzymes, which made them stop taking oxandrolone.

Oxandrolone does not virilize women in low to moderate doses and it has been used in children also. It is an expensive drug, and the manufacturer has created an expanded use program which is probably the most accessible in the AIDS industry. Dosages of 20-60 mg/day for men, and 5-20 mg/day for women have been used successfully. CRIA is participating in a multicenter study of oxandrolone for women with unintentional weight loss and recently completed a similar study in men.

Oxymetholone(Anadrol™)

Oxymetholone is an oral anabolic which was recently reintroduced in the US market last year. It used to be called the "gorilla" steroid by bodybuilders in the 1980's.

A study published in 1996 in the British Journal of Nutrition showed that this powerful oral anabolic steroid improves body weight with what appeared to be no significant side effects in HIV-positive men and women. Oxymetholone was given for thirty weeks at a dose of 150 mg per day. Weight gain averaged 14.5% of bodyweight, which is significant because there was no exercise program instituted, and it is known that anabolic steroids exert their greatest effect when weightlifting is used. Notably, even the subset of patients burdened with AIDS-related infections continued to gain weight on oxymetholone.

While oxymetholone is considered to be a harsh steroid with a high potential for side-effects, the subjects were reported to have no significant problems with liver function, water retention, virilization, and several side-effects thought to be associated with its use. The dose was three times what many bodybuilders would use and the treatment period was considerably longer. Since oxymetholone was brought back to the U.S. early in 1998, we will see how effective it is and also see whether there actually are side-effects in real world situations with HIV positive people.

Steroid

Anabolic*

Androgenic*

Reported Doses

Side Effects

Nandrolone Decanoate
Deca Durabolin

(injections)
Available in the U.S.

High

Low to Medium

Men 100-200 mg/wk
Women 25 mg/wk

Some water retention

Methenolone
Primobolan™ Depot
(injections)

Available in Europe & Mexico

Low to Medium

Very Low

Men 100-600 mg/wk
Women 25-100 mg/wk

No information available.

Methenolone/Primobolan
(Oral = tablets)

Available in Europe & Mexico

Low to Medium

Very Low

Men 50-200 mg/day
Women 100 mg/day

No information available.

Stanozolol
Winstrol™ (injections)

Not available in the U.S.
Can be obtained overseas.

Low to Medium

Very Low

Men 100-200 mg/wk
Women 25 mg/wk

Slight chance of virilizing for women. Pyrogenic (fever-causing). Watch liver function.

Stanozolol
Winstrol™ (Oral)

Available in the U.S.

Low

Very Low

Men 6-18 mg/day
Women 4-12 mg/day

Slight chance of virilizing for women. Watch liver function.

Oxandrolone Oxandrin™ (Oral)
Available in U.S.

Low to Medium

Very Low

Men 15-20 mg/day
Women 10-40 mg/wk
Children 2.5-5 mg/day

Slight chance of virilization for women. Patients on protease inhibitors should watch liver function. Women report water retention.

Oxymetholone Trade name Anadrol™ 50
(oral)

Available in the U.S.

Very High

Very High

Men 150 mg/day
Women 150 mg/day

Balding in men, high blood pressure, water tetention, body hair growth in women and breast enlargement in men. Watch liver function.

Testosterone
Cypionate or Enanthate
(Injections)

Available in the U.S.

High

Medium to High

Men 100-200 mg/wk
Women 25 mg/wk

Water retention, balding in men, acne, breast enlargement in men, may virilize women.

* Many of the above dosages are not based on clinical data. Any individual considering using anabolic steriods should consult their physician. "Anabolic" characteristics are desirable for wasting therapy because it means increased lean body mass (LBM), which correlates with survival in AIDS . "Androgenic" means having a masculizing effect, which is generally undersirable for women. Generally speaking, the less androgenic a steroid is, the fewer side effects there will be. The upper dosage listed for women is usually for severe wasting only. Women's systems do not tolerate anabolic steroids as well as men in general; caution is advised, and high dose is usually reserved for severe wasting.

Optimum Nutrition and LBM

Anabolic steroid therapy is much more effective when a high-protein (one or more grams of protein per pound of bodyweight per day) slightly hyper-caloric diet is maintained consistently, along with resistance weight training (one hour, three to four times a week) and an adequate micronutrient program. Whey protein, a byproduct of cheese manufacturing, is the most bioavailable protein known (eggs and meats follow). One small but interesting study showed that over a three month period HIV patients using whey protein gained between 4 and 15 pounds (without anabolic steroids). This type of new "high-tech" protein has also been shown to increase tissue glutathione levels and glutathione content in blood mononuclear cells, which no other commonly available protein supplement seems to do. It also does not seem to cause GI disturbance, like gas, bloating and diarrhea, commonly seen with other protein supplements.

Resistance Weight Training

Resistance exercise with weights and machines has been shown to increase muscle hypertrophy (growth) with or without the use of anabolic steroids. As previously mentioned, Dr. Shalender Bhasin in Los Angeles determined that HIV negative men receiving injections of 600 mg per week of testosterone and who exercised with weights had more LBM gains than those receiving testosterone but no exercise. Dr. Marc Hellerstein in San Francisco just finished a controlled study using oxandrolone and exercise in HIV positive men. He also found that men who exercised and took oxandrolone were the best responders to therapy.

All exercises should be performed to one's best ability to finish 8-12 repetitions in 3 sets per body part. Splitting the body in three areas ( chest + shoulders + triceps, back + biceps + abs, legs) gives all body parts enough time to recover. The most common and effective exercises are: barbell flat bench press, overhead cable front pulldowns, barbell biceps curl, triceps pushdowns, abdominal crunches, and leg press. Working out with a partner and keeping a workout logbook are also great ways to ensure success.

The use of anabolic steroids for HIV therapy is a complex yet successful way to increase LBM and strength. Without proper nutrition and exercise, this therapy is only marginal in its effectiveness. Anyone who is considering the use of this therapy should become knowledgeable and empowered with information about these compounds, and the optimal nutritional and exercise programs.

For more on hormones visit www.Medibolics.com and www.ExcelMale.com

How to Manage the Most Common Side Effects of Your First HIV Antiretroviral Regimen

Tips From an Activist and a Physician

By , and

Introduction

Starting on HIV medications can be a stressful period. While most medication regimens are easy to handle, side effects occur in many people -- and if you're not prepared to deal with them, they can undermine treatment success.

Side effects are most likely to occur during the first few weeks after you've started taking HIV medications. After that, they usually fade away. If side effects are severe or they cause significant persistent disruption to normal daily activities, be sure to talk to your health care provider; in these cases, additional treatments or a switch to a different medication can usually improve the situation.

However, in many cases, there are simple steps you and your doctor can take to manage side effects during your first few weeks on treatment. You don't always have to "just deal with it."

Here are a few of the most common side effects that the average HIV-positive person might experience while on their first treatment regimen, along with some tips on how to manage them.

Anxiety and Mood Changes

Resources for Doctors and Clinitions

What to Know: Anxiety and other mood problems are an uncommon, but occasionally reported side effect of certain HIV medications, especially Sustiva (efavirenz, Stocrin), which is part of the combination pill Atripla (efavirenz/tenofovir/FTC). (More rarely, people have reported such problems on Ziagen [Abacavir], which is contained in the combo pills Epzicom[abacavir/3TC] and Trizivir [AZT/3TC/abacavir].)

In general, while there are some steps you can take to control anxiety-related side effects, it's important to figure out whether your mood problems are being caused by the meds themselves or by other issues going on your life.

Tips to Discuss With Your Health Care Provider:
  • Consider seeking out the help of a support group, case manager or treatment counselor to help you reduce feelings of depression or stress. This will also help you and your health care provider determine how much of the problem is being caused by the meds themselves and how much is due to other issues in your life.
  • Standard anti-anxiety medications (called "anxiolytics") may reduce feelings of anxiety; these include lorazepam and alprazolam. However, note that such medicines are potentially addictive, so they ideally should only be taken for a relatively short period of time. Many psychiatrists believe that antidepressants are a better choice for long-term use.
  • If the symptoms of anxiety you feel after starting HIV medications persists for several weeks and no other cause is identified (for example, underlying mood problems or depression), then you and your doctor should talk about the possibility of switching out the offending antiretroviral for another HIV medication.

Brain Matters: Strange Dreams; Trouble Sleeping or Concentrating

Resources for Doctors and Clinitions

What to Know: These problems are all considered central nervous system (CNS) side effects. The most common culprit is Sustiva (efavirenz, Stocrin), which is part of the combination pill Atripla (efavirenz/tenofovir/FTC). Insomnia has also been reported among a few people who started Isentress (raltegravir). The CNS side effects of Sustiva are usually worst after you take your first-ever dose and diminish rapidly thereafter. Many people have unusually vivid dreams and some degree of insomnia (trouble sleeping) for 10 to 15 days after they start taking Sustiva, but it's rare to see this continue more than more than six weeks after starting. So be patient if you can, and see if they subside on their own. Keep in mind that, although HIV meds can cause sleep problems, many of these problems have other causes, including behavioral/lifestyle issues and psychological issues. Sorting out the true cause of problems like insomnia can help direct the best approach for dealing with the symptoms.

Tips to Try on Your Own:
  • The more food is in your stomach, the more Sustiva is absorbed into your bloodstream, which may increase the side effects. So make sure to take the medication on an empty stomach, especially when starting out.
  • If you take Sustiva or Atripla at night (most people do), be sure you don't have any critical events scheduled in the first few mornings after you start taking the drug.
  • Try to avoid drinking or eating anything with caffeine for several hours before bedtime.
  • Try to avoid nicotine for 4 hours before bedtime.
  • Do not exercise 2-4 hours before bedtime. Also avoid bright lights, watching a computer screen or television before bedtime.
  • Relax before bedtime by reading, indulging in a bath or drinking non-caffeinated herbal teas like chamomile.
  • If you are a light sleeper, take extra steps to ensure uninterrupted sleep, such as ear plugs or an eye mask.
  • There are several effective over-the-counter drugs available that can usually be used safely for the occasional bout of insomnia, such as Advil PM, Tylenol PM or diphenhydramine (the generic name for Benadryl, an antihistamine).
Tips to Discuss With Your Health Care Provider:
  • Certain Sustiva problems can be resolved by rescheduling the dose. If it's causing insomnia, talk to your doctor or nurse about taking it in the morning instead of at bedtime (although keep in mind that the drug's other mind-altering effects can make it difficult to function during the day). If daytime drowsiness is the problem, take it earlier in the evening.
  • If over-the-counter drugs don't help you, many healthcare providers may prescribe trazodone , zolpidem (Ambien), zalepion (Sonata) or eszopiclone (Lunesta).
  • Consider being checked for sleep apnea, a disorder in which a person briefly stops breathing or breathes shallowly many times during sleep and therefore does not get enough restful sleep. (Sleep apnea is not associated with HIV medications, but it can be an issue if poor sleep and daytime fatigue were also common before you started treatment.)
  • If you still have these side effects after three weeks, let your provider know so that he/she can recommend options. If after trying different options you have no relief, then it may be time to switch to another HIV medication.

Diarrhea

Resources for Doctors and Clinitions

What to Know: Many HIV medications can cause it, but protease inhibitors -- especially Norvir (ritonavir) -- are particularly associated with diarrhea.

Of course, like many of the side effects we discuss in this article, diarrhea can have multiple causes. These include infections, lactose intolerance, digestive issues (such as your body not absorbing fat properly, or "malabsorption"), diet issues (such as ingesting too much sugar or caffeine) and stress.

While some degree of softer stools might be an acceptable side effect, any drug-induced diarrhea that causes a significant impact in your daily activities (when/how you eat, work or play) should prompt a discussion with your health care provider.

Tips to Try on Your Own:
  • Over-the-counter drugs like Immodium, Kaopectate and Pepto-Bismol can work for diarrhea by slowing down the activity of your gut. However, if your diet or the way you schedule your meals is contributing to your diarrhea, it's best to address those problems rather than just treat the symptoms with more drugs.
  • Drink lots of good liquids (i.e., those that are not loaded with sweeteners or caffeine) and eat plenty of healthy food to replace what's lost through diarrhea. It's easy to forget just how many nutrients are passing through your body; diarrhea can make you more prone to problems like dehydration if you don't pay attention.
  • Avoid milk-based products (including whey protein supplements) if you suspect that you may have lactose intolerance.
  • Avoid spicy foods.
  • Glutamine supplements and probiotics can be helpful, especially when used in combination. Take 1 rounded tablespoon of glutamine 3 to 5 times per day (ideally in powdered form, which you can mix with water), for a total daily dose of 30 to 40 grams. Even after your diarrhea is eliminated, consider long-term use of at least 5 to 10 grams daily.
  • Fiber supplements, such as Citrucel or Benefiber, can help, but be careful not to take them around the same time as your medications, since soluble fiber can affect how HIV medications are absorbed into your bloodstream.
  • Metamucil wafers can help: Try taking two 3 oz. wafers before bedtime.
  • Taking pancreatic enzymes (taken in a formula that also contains lipase) with meals can greatly reduce drug-induced gas and bloating and will sometimes also help reduce diarrhea.
  • Calcium carbonate (TUMS): Try 500 to 1,000 mg of calcium carbonate in the middle of meals two to three times per day, but don't go over 2,500 mg total per day.
Tips to Discuss With Your Health Care Provider:
  • In cases of severe diarrhea, a complete medical evaluation is in order.
  • If your health care provider feels it will be helpful, a prescription anti-diarrheal medications such as Lomotil can help control the problem.
  • Diarrhea can sometimes be caused by invading microbes or illnesses. If your health care provider diagnoses you with such an illness, she or he might prescribe you a medication such as metronidazole or rifaximin to treat it.
  • Ultimately, if your diarrhea doesn't go away or is severely impacting the way you live your life, and if it looks like your HIV medications are the cause, you and your doctor should discuss switching to another drug or regimen.

Fatigue (Feeling Tired, Even When You're Not Sleepy)

Resources for Doctors and Clinitions

What to Know: Fatigue can be caused by many factors, including HIV medications. It's not too uncommon to have fatigue in the initial days of treatment, but mild to moderate symptoms often improve over time.

The tricky thing about fatigue is that it can have so many different possible causes. Some of them are tied to HIV medication side effects or other medications you're taking, while others may be related to physical or emotional problems you're going through.

Tips to Try on Your Own:
  • We mentioned earlier that Sustiva (which is found in Atripla) can cause sleep disturbances. Those problems can lead to daytime fatigue and lack of mental focus. If this is the case for you, try to follow the recommendations we provided previously to address sleep problems.
Tips to Discuss With Your Health Care Provider:
  • Over-the-counter supplements: Many supplements are billed as energy boosters, but not all can follow through on their promises, so approach them with caution. Among the authors of this article, Nelson is a fan of SAMe (SAM-e, S-adenosyl-methionine, or S-adenosyl-L-methionine), a naturally occurring compound that is found in every cell in the body and may offset some of the fatigue you feel, although it hasn't been tested in large clinical trials. Also talk to your doctor before taking it, since there is a risk for drug-drug interactions, including interactions with many standard antidepressants.
  • Prescription stimulants: Some physicians may prescribe drugs like armodafinil (Nuvigil), methylphenidate (Ritalin, Ritalin SR, Methylin, Methylin ER) or Adderall when other steps fail. However, there is some concerning data on the use of stimulants and increased cardiovascular risks, so it is important to talk to your doctor about this. If you and your doctor decide that stimulants are a reasonable option, you will need to review the many potential drug interactions, physical health and mental health complications that can occur.
  • If your fatigue is severe (meaning it's having a major impact on your daily life) or doesn't go away a few weeks after you've started treatment, it's important for you and your doctor to make sure that you've ruled out other possible medical causes. There are many causes (each of which has its own potential treatments), including:
    • adrenal gland problems
    • anemia
    • depression
    • heart disease
    • kidney disease
    • liver disease
    • low testosterone levels
    • poor nutrition
    • sleep disorders (including sleep apnea and restless leg syndrome)
    • thyroid disease
  • If after a careful evaluation, the only apparent cause or persistent fatigue is HIV medications, then you and your doctor can consider a switch to an alternative regimen.

Headache

Resources for Doctors and Clinitions

What to Know: There are multiple causes of headaches that may or may not be related to HIV meds. It's important to distinguish between medication side effects and other causes. While most headaches are harmless in and of themselves (though painful), there are serious (but rare) problems that can have headaches as symptoms. To provide just a few examples, these non-medication-related causes of headache include:

  • High blood pressure
  • Magnesium deficiency (rare in general, but possible more common among HIVers)
  • Migraine or cluster headaches
  • Rarely, disorders of the brain or neck (infections, tumors, stroke, aneurysm)
  • Sleep disorders
  • Stress
  • Vision problems
Tips to Try on Your Own:
  • The most common way people treat mild headaches is with an over-the-counter medication, particularly aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin) or naproxen (Aleve). However, although you can do this on your own, be careful about it, and speak with your doctor if you have any concerns:
    • Be sure to stay within the recommended doses to avoid drug toxicity. Also be aware thateven over-the-counter pain relievers have their own potential risks, many of which can be in people with HIV:
    • People with active liver disease (including people with chronic hepatitis infection) should avoid the use of acetaminophen. People with low glutathione levels (common in people with HIV) should also taken acetaminophen with caution.
    • People with kidney problems, ulcers, low platelets and low serum albumin levels (common in those with wasting) should use caution when taking acetaminophen, aspirin and ibuprofen.
Tips to Discuss With Your Health Care Provider:
  • Persistent or severe headaches should be brought to the attention of your health care provider. If antiretroviral medications are the culprit and the headaches are making you miserable or having a big impact on your life, switching HIV medications will usually improve the situation if one of your current drugs is causing it.

Nausea, Upset Stomach, Vomiting

Resources for Doctors and Clinitions

What to Know: Any HIV medication can potentially cause nausea and other related problems (called "gastrointestinal" problems). Nausea and vomiting can be serious side effects. There are many different strategies for dealing with nausea. If you have serious nausea, especially when it's accompanied by abdominal pain, you should contact your health care provider right away. At its worst, nausea and vomiting can prevent you from digesting your meds properly, which can make your treatment less likely to succeed.

Tips to Try on Your Own:
  • Pay close attention to the dosing instructions on your HIV meds: Some meds need to be taken with a meal in order to avoid nausea, while for others an empty stomach helps.
  • Ginger. It's available in many forums, including a syrup that can be put in a beverage you can sip throughout the day; supplements (two 500-mg capsules, 2 or 3 times daily with meals); and ginger ale (brands that contain a potent blast of ginger, usually available in health food stores, work better than standard varieties). Chopped ginger root can be added to many dishes where it will add its spicy flavor along with its ability to counter nausea.
  • Eat small, frequent meals instead of two or three large ones (a full stomach makes nausea worse).
  • Munch on snacks every three hours; don't let your stomach get too empty or your blood sugar too low.
  • Crunch down on dry, salty crackers or pretzels prior to eating and taking meds. (Bonus: Salty foods are usually better to snack on than sweets.)
  • Sniff grated lemon peel or drink water with lemon in it just before eating.
  • Supplements containing "good bacteria," such as acidophilus and bifidus, can improve digestion and reduce gas.
  • Chew slowly and eat in a calm, relaxed environment.
  • Since maintaining your food and fluid intake is crucial for health, if your nausea waxes and wanes, try to be aware of the times you're feeling better. Use these times to drink lots of fluids and take in lots of protein and calories, in order to make up for the times when you don't feel as good.

Managing Gut Symptoms Managing Gut Symptoms (A free PDF)

Tips to Discuss With Your Health Care Provider:
  • Consult your doctor or pharmacist to determine whether it might help to take the offending HIV medication at a different time of day.
  • Anti-nausea (anti-emetic) drugs can often reduce or eliminate the problem. Ask your pharmacist to check for drug interactions before trying medications such as dronabinol, ondansetron, prochlorperazine, promethazine, trimethobenzamide , or medical marijuana (where it's legal).

Rash

Resources for Doctors and Clinitions

What to Know: Skin rashes can occur as a side effect of many HIV medications, more commonly among people taking non-nukes (including Sustiva, which is part of Atripla; Viramune [nevirapine]; and Intelence[etravirine]) and some protease inhibitors. Rash is also one of the symptoms people experience if they have a hypersensitivity reaction to Ziagen (abacavir), one of the drugs in Epziom (abacavir/3TC) and Trizivir. However, this reaction is very rarely seen in people who have had a routine genetic screening test for it (called HLA B*5701) and know whether they need to avoid the drug. Besides HIV medications, some non-antiretrovirals that are commonly taken by people with HIV (for example, Bactrim and Septra, which treat pneumonia) can make your skin sensitive to the sun and make it easier to get sunburned.

Rashes can either be localized (occurring on one specific part of your body) or generalized (occurring everywhere). Keep in mind that if your rash is localized, it's probably not a medication causing the problem -- it probably means that part of your body has come into contact with something that's irritating it.

Most rashes that develop after starting a new medication are caused by an allergic reaction to the medication, and they'll worsen with each dose that you take. If this happens to you, it should prompt a call to your health care provider.

Tips to Discuss With Your Health Care Provider:
  • If your rash is mild, it may not require you to stop or switch your HIV medications. If you tell your provider quickly, she or he can usually help prevent them from getting serious (and can hasten their improvement, too).
  • Signs of a serious drug allergy usually include more than just a rash: There can be fever, shortness of breath, oral sores, nausea and vomiting -- though not necessarily all of these symptoms have to happen in order for you to be having a severe allergic reaction. If you feel any of these symptoms during the first few days after you begin treatment, you should contact your healthcare provider immediately.

This article was provided by TheBody.com. You can find this article online by typing this address into your Web browser: http://www.thebody.com/content/63238/how-to-manage-the-most-common-side-effects-of-your.html

Making Sense of Supplements

By
December 18, 2012

The world of nutritional supplements is a confusing one, with thousands of claims that are not supported with clinical studies, or are based on research done in rats. There is no FDA oversight of these claims, and quality control audits of this industry are infrequent. However, the FDA is known for sending warnings about supplements that have been reported to cause health concerns, or with unapproved ingredients found in random testing.

Research on supplementation in HIV slowed down considerably when effective antiretrovirals with better side effect profiles were approved. However, there are still certain quality-of-life and metabolic issues that many of those of us living with HIV try to manage not only with prescribed medications but also with over-the-counter supplements. But which ones are worth the expense due to positive studies in HIV?

In my search for trustworthy data on different supplements to improve the effects of HIV and its medications on my body and health, I have found a few supplements that have some data in HIV and health. Some are aimed at improved stamina, gut health, lean body mass, bone health, cholesterol/triglyceride levels and mood.

In this short video, I review some of supplements that I personally use after reviewing available research studies (most done in HIV-positive patients). Keep in mind that the mentioned brands are just examples and not in any way an endorsement for those companies. No funding was received from any company to make this short video. For a good website to explore supplement companies whose products have been tested by a third party, visit ConsumerLab.com.

Discuss any use of supplements with your physician before starting them.

Most of the supplement ingredients discussed have been studied in HIV without adverse effects on CD4 cell count and HIV viral load. But keep in mind that drug-supplement interaction studies are limited in HIV.

If you have any questions, you can send them to me via my Ask the Experts forum on Nutrition, Exercise and HIV.

For other sources of information on supplementation in HIV, read:
Ask questions about nutrition, supplementation, aging, hormones,treatments and more:
http://www.thebody.com/Forums/AIDS/Nutrition/ask.html

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