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Chester Myers' Nutrition Series Information relating to HIV & Nutrition: HIV & Liquid Food Supplements Sometimes one needs food in an easy-to-take form. The information here is about things to look for in food supplements you can drink.
NOTE: Pertinent references, some noted within the text of this document, are included in References for HIV & Nutrition Vol. 1 & 2 of this series INFORMation relating to HIV & Nutrition, or in a database owned by the author. Eating well and quality of life are closely related. Quality of life may also be useful to monitor the effectiveness of programs you use to give you resistance (resilience) against infections. One way to understand quality of life in terms of the factors that contribute to well-being is given in the accompanying diagram. Wellness Diagram
Quality of Life
|
| Healthy
| ___________________
| /
| _/ |
| ___/ |
| / | |
| Not / | |
| Healthy / | PLWHIV |
| _/ | |
| / | |
| / | |
| / | |
| / | |
| _/ PLWAIDS | |
_/ | |
0 ___/ | |
/ -------------------------------------------------------
0 Stress control/exercise/nutrition/meditation
(Factors contributing to Health)
Along the horizontal scale (across the bottom of the diagram) things such as management of stress, feelings of self-empowerment, exercise, good nutrition, absence of disease and happiness move you to the right along the curve, with a corresponding increase in quality of life and greater resilience to infection. Poor nutrition, illness and other negative influences move you to the left with a decrease in well-being. Someone who is very healthy would be on the right, on the plateau part of the curve. The slanted lines indicate a division between good and poor health, with an intermediate region where a person could feel either healthy or unhealthy, depending on the combination of contributing factors. On the "healthy" plateau, an infection such as a cold would cause a certain move to the left with only a minor decrease in quality of life. A person who already has a serious health problem would be closer to the cliff part of the curve, left of the slanted line and, here, the same cold, although causing the same move to the left, would result in a much greater drop in quality of life. One could generally view those living with HIV (PLWHIV) as being in the central section, left of and overlapping the upper "healthy" plateau; a person living with AIDS (PLWAIDS) would be further to the left, yet still have potential for feeling healthy. The placement of the slanted lines between "healthy" and "not healthy" is arbitrary since many who have been defined as having AIDS are able to attain and maintain an otherwise healthy status, often for many years. While a pessimist might say that for a person near the cliff part of the curve, every little problem may be major, an optimist would say that here, every little bit of help may have a greatly beneficial effect. Applying the above concept to nutrition, eating well takes on greater significance for a person with a major illness than for one who is fully healthy. Every little bit of good may help. Getting enough calories is very important since the HIV virus not only increases your need for energy, but also decreases the proportion of your food that is absorbed from your gut. Moreover, because of the unusual demands on the immune system, your antioxidants, vitamins and minerals are also used up at a faster than normal rate. This means you also need more of them than would a person without HIV. Maintenance of body weight, especially of lean body mass (protein), should be given priority since our immune systems need protein in order to function. While quantity of calories is certainly important, in HIV disease the quality of protein, fat and carbohydrate in your diet is particularly important. Sometimes it may be necessary to supplement one's food with liquid food supplements. These products contain some or all of the macronutrients, protein, carbohydrate and fat, as well as micronutrients, vitamins and minerals. When they are called "complete", they contain enough of each of the important ingredients considered essential to keep you alive if you eat/drink enough of the product. Criteria of completeness are normally determined without consideration of special nutritional concerns that derive from HIV. Thus, these "complete" supplements should not be relied upon as the only source of nutrition unless absolutely necessary. That is, whenever possible, use liquid supplements to supplement regular meals, not to replace regular food. They are low in dietary fibre, if they contain any at all, and don't usually contain important materials such as bioflavonoids which we get in our regular foods. Try to use liquid food supplements at times when they won't rob you of your appetite for regular food. The quality of liquid food supplements takes on increased significance for those on the cliff of the wellness diagram. If supplementation supplies a major part of your food, the food supplement needs to be not only "complete", but also should contain these ingredients in high quality forms. If taken only to augment the calories of an already adequate or close-to-adequate food intake (that is, your quality of life is more to the right and closer to the upper plateau part of the curve), a supplement that is not complete or of lower quality could be considered. A few considerations are given here to help choose a good food supplement. In general, it is always wise to be aware of, and avoid, allergy-type or intolerance reactions that derive from a specific product. Cramps, bloating, diarrhea, skin rash or headaches could be signs of such reaction. In general, liquid food supplements should be low in simple sugars (those whose names end with the letters 'ose'), and the fat should not contain high proportions of vegetable polyunsaturated oils, such as corn, soy, sunflower or safflower oils. It's best if soy protein is not present, but this is likely important only for some people, for example who have obvious gastrointestinal problems or who know they get bloating, gas, headaches or other negative reaction from soy products. Studies have shown immune suppression occurs, especially of cell-mediated immunity, from fats such as corn or soy oils, the type of fat found in some liquid food supplements (Brouard and Pascaud, 1993; Chan et al, 1993; Fernandes and Venkatraman, 1993; review containing 116 references by Kinsella et al, 1990; Soyland et al, 1994). Concern here is greater in cases involving some opportunistic infections where the same immune suppressive agents that result from oils such as corn and soy are also elevated by opportunistic infection (Castro et al, 1993; Kinsella et al, 1990). Many products that contain the wrong type of fat also contain poor quality carbohydrate and/or protein, and should be avoided. I attempt here to give guidelines to help people living with HIV/AIDS (PHA) in choosing appropriate liquid food supplements. It is assumed that PHAs already take a multivitamin/minerals supplement and extra of some vitamins and minerals (e.g., vitamins C, E, and minerals selenium and zinc). Therefore the vitamin/mineral content of liquid food supplements is not considered here as a criterion of choice. It is also assumed that N-acetyl cysteine (NAC) is taken as a supplement.
The information here is offered as guidelines, but should not be considered comprehensive. The following are some things to consider when you choose a food supplement. To help digest your food, it may help to take supplemental digestive enzymes such as Daily Essential Enzymes with your meals. Both betaine hydrochloride and glutamic acid hydrochloride may also help digestion by increasing your stomach acidity. Betaine supplies several other useful functions, including giving you a supply of dimethylglycine, often also recommended as a dietary supplement. Some people alternate these, taking betaine HCl one week and glutamic acid HCl the next. Finally, acidophilus/bifidus supplements with your meal can help digestion and help keep your intestines in good shape. Which Fats? Fat is a major component of the food we eat. Fat molecules contain a backbone to which is connected either one, two or three fatty acids. These fats may be respectively called monoglycerides, diglycerides and triglycerides, or, as a group, simply as glycerides. [Another name for glyceride is acylglycerol; thus, there are mono-, di- and triacylglycerols.] There are a variety of fats, also based on the types of fatty acids attached to the backbone. These fatty acids may be saturated or unsaturated. If unsaturated, they may be monounsaturated or polyunsaturated. In addition, the length of the fatty acid molecule (often called a fatty acid chain) varies, so that there are 'short' chain, 'medium' chain and 'long' chain fatty acids in the fats of our diet. Thus, there are medium chain glycerides, and if the backbone contains three medium chain-length fatty acids, the resulting fat is called a medium chain triglyceride, abbreviated as MCT. Unsaturated fatty acids are additionally distinguished by where the unsaturation(s) occur(s) in the chain. Another distinguishing feature of unsaturated fat is a sort of right vs left handedness of the molecule; thus there is a cis and trans classification. Chemical modification of polyunsaturated fats to less unsaturated (i.e., more saturated) forms may encourage a trans shape. Saturated fats are high in animal fats, including butter, and in some plant fats such as coconut. Of these, butter and coconut contain reasonable levels of medium chain-length fatty acids. Monounsaturated fats are high in olive and canola oils. These have long chain lengths. Polyunsaturated (more than one degree of unsaturation) fats are high in other plant oils such as those from corn, soy, sunflower and safflower, and in fish oils. In our digestive system, fats are broken down to their individual fatty acids or intermediate forms. These are then used by our bodies for several purposes. Fats provide us with energy Fatty acids help provide us with energy because of their calories. While fats may give high calories in foods, they also make us feel full fast so they are not necessarily the best way to increase our calorie intake when eating is difficult. In producing energy for our bodies, the fatty acids are burned in cells of the body by a process called beta oxidation in small organelles (inside the cells) called mitochondria (think of these as furnaces). This occurs at very high levels in our muscles and liver. The long chain fatty acids are taken into the mitochondria by a compound called carnitine. Carnitine tends to become low in HIV disease, although those who supplement with N-acetyl cysteine (NAC) are less likely to become as deficient as those who do not take this supplement (see reviews by Myers, 1993). Medium chain length fats can provide energy without requiring carnitine for transport, without encouraging feeling full early, and with faster energy production, all reasons why medium chain triglycerides (MCT) are valuable as part of the fat in liquid food supplements. Some of the fat we eat gets converted back to fat and is stored in our body. This can be used later as required. Our body fat also comes from non-fat parts of our food - yes, from proteins and carbohydrates, so that eating a fat-free meal doesn't mean we'll not store fat in our bodies. In HIV disease there is often an increased tendency for formation of fat, likely a result of low carnitine. Thus, instead of being burned for energy, fatty acids are converted back to fat which in turn gets re-broken down to fatty acids, then re-made back to fat in a process referred to as futile cycling. This cycling wastes energy and contributes to weight loss that may encourage loss of protein, since protein is then forced to provide a large part of the energy required for this futile cycling. The result can be a body that has high levels of triglycerides, and, generally, a higher proportion of fat, at the expense of valuable protein. Protein provides energy for the immune system, and low protein can be a source of diminished immunity. (Grunfeld and co-workers, 1991, 1992; Kotler, 1992) [Most common methods of lean body mass assessment are inaccurate as a result of this phenomenon (Kotler et al, 1985; Wang et al, 1992). If calibrated for HIV, bioimpedance analysis is currently a recommended method for lean body mass assessment.] **To help digest your food, it may help to take supplemental digestive enzymes such as Daily Essential Enzymes with your meals. Both betaine hydrochloride and glutamic acid hydrochloride may also help digestion by increasing your stomach acidity. Betaine supplies several other useful functions, including giving you a supply of dimethylglcine, often also recommended as a dietary supplement. Some people alternate these, taking betaine HCI one week and glutamic acid HCI the next. finally, acidophilus/bifidus supplements with your meal can help digestion an help keep your intestines in good shape. Fats provide materials that regulate much of our bodies' chemistries, especially immunity Very special, and very important, compounds called eicosanoids are made in our bodies from the fat we eat. The process involves an initial formation of arachidonic acid and other related compounds which then are converted to the eicosanoids - the process is called the eicosanoid cascade. There are three subdivisions to these eicosanoids - thromboxanes, leukotrienes and prostaglandins. These are hormone-like materials that control many processes in our bodies such as blood flow, platelet aggregation, digestion mechanics, breathing functions, etc. Some of them work as pairs so that one will turn on a process while the other shuts the same process off. They do their work only in the cells in which they are made (Hunt and Groff, 1990). The eicosanoids interact with and help control the immune system, especially those parts involving inflammatory reponse (Kinsella et al, 1990; Yaqoob and Calder, 1993). Control of several cytokines such as interleukin-1 and tumour necrosis factor is by the eicosanoids. Sperm-associated immune suppression derives from this route (Stites and Terr, 1991). "In general, the dietary studies indicate that diets high in PUFA (soybean, corn, sunflower, safflower oil) suppress mitogenic response of splenocytes and T cells (though this may vary with T cell type), and reduce immune competence. .." ".. while very low levels of LA are required for immune functions, high intakes of n-6 PUFA may be immunosuppressive." (Comment: n-6 PUFAs are types found in corn, soy, regular sunflower and safflower oils.) "Dietary fats containing different fatty acids affect the immune reponse, particularly those fatty acids which affect [AA, arachidonic acid] levels in tissue. Thus, diets containing mostly corn oil, which is composed predominantly of LA, the precursor of AA, results in significant suppression of the mitogenic response .. of lymphocytes isolated from monkeys." "Because of their facile hydrolysis, absorption and ease of oxidation to yield energy in the ill patient, medium chain triglycerides (MCT) are widely used in oral supplementations.. Because enteral formulas and parenteral emulsions usually contain a preponderance of n-6 PUFA, i.e. LA, there is concern that these may increase tissue AA levels .. Such a situation should be quite undesirable in immune compromised patients." (underlining added here for emphasis) "In healthy humans the consumption of fish oil (18 g/day for six weeks) caused a significant reduction (30%) in secretion of tumor necrosis factor.." "Dietary LA does exert significant effects on the immune system and the available data suggest that the intake of n-6 PUFA should be curtailed in diets or formulas of subjects/patients who are predisposed to or are suffering from a depressed immune system .. The inclusion of n-3 PUFA and perhaps MCT in such diets would seem to be beneficial.." Kinsella et al, 1990 "In vivo delayed cutaneous hypersensitivity .. was depressed by linoleic acid and safflower oil, but not by fish oil diets" Hummel, 1993 NOTE: Major sources of linoleic acid (LA) are corn, sunflower and soy oils. The balance of the various eicosanoids derives partly from compounds that change the behaviours of the enzymes involved in eicosanoid formation. For example, aspirin is well-known to inhibit the enzyme cyclo-oxygenase, thus reducing prostaglandin and thromboxane formation, hence providing an anti-inflammatory response. Another factor that influences the eicosanoid balance appears to be the type of polyunsaturated fats dominant in the diet. This is exemplified by the ability of a fish oil fatty acid to substitute for arachidonic acid in certain processes of the body (Hunt and Groff, 1990). "An excess of polyunsaturated fatty acids in the diet is highly immunosuppressive", and this is effected mainly in the cell-mediated immune reponse, whereas a deficiency can reduce the humoral response (Stites and Terr, 1991). Since cell-mediated and humoral immunity tend to see-saw with each other, a deficiency (but not recommended) of polyunsaturated fatty acids enhances cell-mediated immunity (Kinsella et al, 1990). While polyunsaturated fatty acids, in general, may cause certain types of immune suppression, those from corn, soy, sunflower, safflower are of greatest concern. Those from fish may have some beneficial effects. Corn oil has been observed in many studies to cause dramatic immunosuppressive effects (Kinsella et al, 1990). Fats high in monounsaturated fatty acids, fish oil and MCT can be used to replace/dilute PUFAs from corn, soy, sunflower or safflower oils. Not surprisingly therefore, significantly positive results, including enhanced immune functions and weight gain, were observed in a study with orally administered Impact™, a liquid supplement containing fish oil (Singer et al, 1992). More recently, Advera™ a product developed for PHAs with special consideration given to the importance of type of fat in immune function, has included fish oil with MCTs and canola oil (a monounsaturated fatty acid source); "the amount of n-3 is higher relative to n-6, which is beneficial to persons with HIV infection because n-3 fatty acids have a role in immune response" (product monograph "Advera™ Specialized Nutrition"). Practical Considerations Fat should be in a form that's easy to digest. Oils containing only long-chain fatty acids may be difficult for PHAs to properly digest, especially when the compound carnitine is deficient. It is still important, however, that adequate essential fatty acids are provided. A solution to these issues is to choose products containing a blend of polyunsaturated with monounsaturated oil and/or saturated fat, and medium chain-length glycerides. Olive and canola oils are sources of monounsaturated oils. Beef, milk and coconut fats are sources of saturated fatty acids. Several products have combinations with MCT, medium chain triglycerides prepared from coconut fat. Cold pressed flax, evening primrose, cold water fish such as mackerel and salmon, and extra virgin olive oils are other reasonable sources of fat. Peanut oil is preferable to corn or soy. Another source of fish oil may be the small amount that remains in sardines that are canned in olive oil, in water, or in tomato sauce. Some varieties of sardines are sold in soy oil, so eat less of this type. Similarly, when buying peanut butter it's best to avoid those with oils (such as soy) other than what comes from the peanut. Olive and canola are both sources of monunsaturated fats and should be considered superior to corn, soy, safflower and regular sunflower. A special sunflower oil which is high in monunsaturated fats can be considered as equivalent to olive and canola oils. In general, PHAs should avoid products whose sole fat source is corn, soy, safflower or regular sunflower. See the concluding table of some liquid food supplements for more comments. Which Carbohydrates? While oral candidiasis continues to be common in HIV disease (e.g., Ficarra et al, 1994), candida infections in the oesophagus are of greater concern. In 1990, oesophageal candidiasis was reported to be second to Pneumocystis carinii pneumonia as one of the most common early manifestations of HIV disease (AIDS, vol. 4, p. 233). In another report regarding survival times, it was noted that the relative hazard associated with oesophageal candidiasis was 1.5 times higher than from PC pneumonia, and that there was poorer survival at 12 months after diagnosis than for either cryptococcal meningitis or disseminated CMV (JAIDS, vol. 4, p. 144). A recent Canadian report notes that in the period from 1987 to 1991, the rates of oesophageal candidiasis increased (Montaner et al, 1994). Moreover, while some very good antifungal drugs have been developed, there is increasing evidence of resistance to those that are available (Millon et al, 1994; Vuffray et al, 1994) Clearly, candidiasis must be considered a serious opportunistic infection, and those living with HIV/AIDS (PHAs) should do whatever possible to prevent its occurence or slow its growth. Restriction of simple sugars from the diet is one thing that PHAs can do. Carbohydrates that are more complex are not as readily available for yeast growth, especially in the mouth and oesophagus where natural prevention is weaker than in other parts of the gastrointestinal tract. It is important to be aware that major sources of sugar include not only soft drinks, but also several common liquid food supplements such as Boost*, Resource® and Ensure®. Industry Knows about the Sugar-yeast Connection! In industries that either produce sugar syrups or culture yeast it is generally recognized that yeast grow well on simple sugars. This is simply stated in an advertising brochure, Corn Products: The Dextrose Advantage, by CPC International Inc. viz "Because it is a monosaccharide, dextrose is unsurpassed as the carbohydrate source for yeast and other organisms." The bread baker recognizes this when using his/her yeast; if no sugar is present, the yeast does not grow well, if at all. Similarly, the beer brewer recognizes this when s/he makes sure there is adequate glucose in the brewing mix; if there is too much glucose, the yeast grows too fast and good beer flavour is not developed. There is no evidence that, when in the human body, yeast change their dietary preferences. It is therefore no surprise that many PHAs have experienced the importance of keeping simple sugars low in their diet. The yeast of concern here is one called Candida albicans and is the cause of thrush, oesophageal candidiasis and other infections. Generally, one recognizes the simple sugars by the ending "ose"; common simple sugars are either monsaccharides such as glucose (dextrose) and fructose, or disaccharides such as sucrose and maltose. Some time ago I echoed the CPC advertising, and made it relevant to those living with HIV/AIDS by noting that "High levels of sugar should be avoided. .... These are favourite foods for yeast infections in the throat (thrush) and oesophagus (oesophageal candidiasis). Food supplements that have simple sugars listed among their first ingredients are best avoided by one who is HIV positive." (Myers, 1992). What is the Evidence for the Sugar-yeast Connection? In primate research it has been shown that glucose and sucrose both promote Candida yeast growth, and that the absence of these sugars during tube feeding discourages yeast growth, viz. "candida was not detectable in tube-fed animals and reappeared when the animals were fed a high carbohydrate [glucose or sucrose] diet" (Bowen and Cornick, 1970). These same authors note that those who wear dentures are more susceptible to oral "growth of candida". Similarly, use of both icing sugar and icing sugar plus tetracycline were associated with "oral candidal infection" in rats (Hassan et al, 1985). Another study with icing sugar plus starch studied the mycelial growth phase of Candida in rats, and found that this carbohydrate rich diet encouraged persistence of the Candida albicans (Russel and Jones, 1973). An in vitro study found that glucose added to human saliva stimulated Candida growth (Knight and Fletcher, 1971). Similarly, an in vivo study found that sucrose rinses encouraged Candida growth in denture wearers (Olsen and Berkeland, 1976). Although my greatest concern has been that dietary simple sugars will encourage thrush and oesophageal candidiasis, a study in mice raises the possibility that even yeast levels in the rest of the body may be elevated by high levels of dietary sugar. These authors conclude that "the data provide an experimental rationale for clinical trials to decrease the intake of glucose or its utilization by C. albicans in immunocompromised patients" (Vargas et al, 1993). Furthermore, an earlier study found that high levels of simple sugars caused severe immune suppression, particularly the activity of neutrophils which help fight bacterial and fungal infections (Sanchez et al, 1973). This immune suppression is highest for the first 2 hours after eating the sugar, but is still present after an additional 3 hours. Starch, on the other hand, did not produce immune suppression. Some medications used to treat candidiasis may contain sugar. For example, if the doctor prescribes a nystatin suspension (the yellow stuff!) for PHAs, the pharmacist should be requested to supply it without sugar. After all, why feed the infection you are trying to kill? PHAs need to be aware of the sugar content of foods they eat. A good practice following meals is to rinse the mouth out with water to get rid of residual materials from your food that may promote thrush. Gargling with a mixture of water with a few drops (per tablespoon of water) of Te Tre Oil or NutriBiotics® (also called Citricidal™, a grapefruit seed extract; Para Microcidin™ is a similar material by another company), or a solution of from 1% to 3% food grade hydrogen peroxide may help discourage yeast infections. It is important to NOT swallow hydrogen peroxide since it can damage the oesophagus as well as the stomach.
Just as it is obvious, without proof-type studies, that humans require a variety of foods to stay alive, so it is obvious to those who cultivate (grow) yeast that one does not require proof-type studies to show that yeast grow well on simple sugars. In fact, a variety of studies have noted that such organisms in the mouth do quite well on sugars such as icing sugar. It is no surprise that in studies of yeast & sugar that sugar is added to the yeast culture to keep the yeast alive! It is also disconcerting that Kielo et al (1993) comment that a doctor can be consulted for candidal infection, as part of an argument against concerns over high use of simple sugars. Are we also to discourage warnings about eating raw eggs for PHAs since Salmonellosis can be treated by a doctor? Deaths from candidal infection far surpass deaths from Salmonellosis in PHAs, and there are far more medications available for treatment of salmonellosis. But NO, eating raw eggs and/or high levels of simple sugars should be discouraged. There are, again, special concerns regarding use of liquid food supplements by PHAs. The carbohydrates used in these vary from maltodextrins to simple sugars. Sipping these over a period of time exposes any residual candida in the mouth to its favourite food thus encouraging its growth. Products that should be avoided by PHAs include Boost, Ensure, Resource, and Sustecal. Excellent-to-good products include Advera, Peptamen, Nutren, Vivonex, and Isocal. Carbohydrates should provide you with a good level of soluble dietary fibre which helps control both diarrhea and constipation. Dietary fibre also provides food for your intestinal flora ('gut bugs') which discourage intestinal infection, and produce vitamins and other important compounds. Poor growth of the friendly gut bacteria encourages yeast growth. The remainder should be natural carbohydrates such as starch from vegetables and cereals. The carbohydrate component normally contains some simple sugars such as sucrose to improve taste. A major portion of the carbohydrate, however, should be provided by maltodextrins that have a low "dextrose equivalent", i.e., DE, value, preferably 10 to 30. A portion of soluble fibre such as pectin would also be good. Products that contain lactose should be used with caution, especially if there is lactose intolerance. Maltodextrins are produced from starch, and are characterized by a Dextrose Equivalents (D.E.) value which indicates how 'close' to simple sugars they are. The higher the D.E. number, the closer they are to simple sugars. Generally, it's good if maltodextrins in your liquid food supplements have a D.E. below about 40. If the D.E. value is too low such as 10 or less, it becomes more difficult to keep the product flowable, so there are practical considerations in formulation that must be considered. Since D.E. values are not normally supplied on labels, which maltodextrins have been included are usually not readily evident. However, contact with the manufacturer should make this information available. Which Proteins? Protein should be of high quality. Egg, rice, soybean, casein and whey are some sources of good proteins. Egg, casein or whey proteins are normally very high in quality. Partially hydrolyzed protein may be useful if digestion is difficult. Some proteins are easier to digest than others. Several may be the origin of problems in the gastrointestinal tract. In general, milk proteins are easy to digest; however, the carbohydrate lactose may be a problem for some people. When casein or caseinates are found on the ingredient list this usually means that any lactose was removed before the protein was added to the supplement. In some other cases, mucous build-up may become a problem from milk products. In cases where a 'productive cough' is already present, this could present further problems. Soy-based products may be useful as a source of protein, and of calcium when in the form of tofu. However, there may be concerns that could have ramifications for people with compromised digestion. A licensed nutritionist from Florida state who speaks at the Manasota AIDS conferences suggests soy-based supplements be used with caution, that rice milk provides a better protein source for PHAs. While containing fewer calories, these are readily compensated by other ingredients. Dr. Lark Lands has also noted that PHAs frequently present with gastrointestinal problems that go away when the person stops using soy-based products. Not only may soy protein be difficult to digest, but its use is frequently accompanied by allergies. Soybeans have been noted to provoke "gastroenteric symptoms through direct irritation and certain pharmacologic activity" (Metcalfe, 1992). Since additional deterioration of the small intestine could be quite dangerous, this issue should be of special concern if anyone senses a problem from soy-containing products. While isolated or fractionated protein products may not have certain antinutritional factors that are present in the whole bean, high use of any of these may be inadvisable. In the presence of HIV such problems are likely to be accentuated since low stomach acidity can increase the absorption of intact allergens from the gut. Colitis has also been noted to sometimes result from hypersensitivity to soy protein. (Sampson, 1992). The known allergens in soy include the major storage proteins (glycinin and conglycinin) which are the main proteins in drinks that rely on soy as their source of protein. It is difficult to avoid allergens completely and this makes it important for various choices of protein to be available. In general, any one known source of major allergens should be used with discretion and sensitivity. Soy and rice drinks may be convenient alternatives to cow's milk. It may be necessary to avoid cow's milk if you are lactose intolerant, and if use of lactase enzyme supplements don't help. You can consider rice milk (for example, Rice Dream) either in combination with soy milk, or as the sole replacement for cow's milk. Some ready-to-drink liquid food supplements rely on soy as their sole source of protein. Other food supplements have soy protein that is diluted with another protein source such as caseinates (from milk). Still other drinks avoid use of soy proteins. The concluding table lists proteins of some common commercial liquid food supplements. Another consideration for proteins is their content of the sulphur-containing amino acids, cysteine (or cystine) and methionine. Often these are low in food. A deficiency of cysteine in the body can result in many bad effects including wasting, and HIV is known to suppress this compound in the body. Content of cysteine in the proteins used as ingredients in liquid food supplements has not been considered as an important criterion here since supplementation with N-acetyl cysteine (NAC), to replenish body cysteine, is considered essential for all who have HIV in their bodies. If for some reason, NAC is not being taken as a supplement (for example at a level of 2 to 3 grams per day), then information about the cysteine content of food supplements becomes of extreme importance. This information is available from the manufacturers. For completeness, a food supplement may also have the micronutrients, vitamins and minerals. However, the quantities are usually quite low and will be unlikely to allow you to reduce your normal vitamin/mineral/antioxidant supplements. Other valuable compounds such as N-acetyl cysteine (NAC) and carnitine are provided in only a few products. What then, are reasonable food supplements to use when your digestion is poor, energy is down, and you are losing weight? First of all, remember that food supplements should SUPPLEMENT your food and NOT replace it, if at all possible. To make sure you don't eat less regular food, you can take a food supplement at the end of a regular meal, or at bedtime when it will not interfere with your meals. If it is absolutely necessary, sometimes a "complete" product must be used for a period of time. It is here that the quality of the product is of utmost importance. Even though called "complete" they don't contain compounds such as bioflavonoids which are contained in many real foods, and which may be of benefit, even helping to slow growth of HIV. Currently, some reasonable liquid food supplements for PHAs include Advera, IsoCal, Nutren, Peptamen, Vivonex..
There are several good products you can use to make your own liquid food supplement, including:
Recipe 1: Recipe 2: ½ cup each of soy drink and rice milk 1 cup cococut/pineapple nectar ½ peeled banana ½ cup each of soy drink and rice milk ½ peeled apple ½ peeled banana 1 teaspoon flax oil ½ peeled apple Recipe 3: Recipe 4: 1 cup rice drink 1 cup rice drink ½ cup cranberry juice 1 cup coconut/pineapple nectar ½ peeled banana ½ peeled banana ½ peeled apple ½ peeled apple 1 teaspoon flax oil 1 teaspoon flax oil Recipe 5: Recipe 6: ½ cup rice drink ½ cup rice drink ½ cup soy drink ½ cup soy drink ½ cup coconut/pineapple nectar ½ cup cranberry juice ½ peeled banana ½ peeled banana 1 teaspoon vanilla flavouring ½ peeled apple 1 teaspoon flax oil. You can try your own combinations. For example, use a whole banana without any apple; use Pure MCT in place of flax oil, or even use both of them; if you like a slightly tart taste, try the cranberry juice with other combinations. A scoop of the Twinlabs hydrolyzed protein product,or of Solgar's Whey-To-Go product (an excellent protein supplement) will make these even more nutritious, and will especially help you build up your muscle tissue. If you like a yoghurt-type taste, try equal quantities of Knudsen family cranberry juice and soy drink; this combination can be a good thirst quencher. A scoop of Hagen Daz ice cream often makes these drinks even more tasty and nutritious. ----------------------------------------------------- Comments given here do not consider the cysteine content of the protein, and assume clients take supplements of N-acetyl cysteine (NAC) to minimize risk of cysteine deficiency (1-3 grams of NAC per day is taken by many). Otherwise, the protein and overall ratings here could be different, since the cysteine content of the protein would then be of vital importance. ** Products containing soy protein may cause gut deterioration or allergies in some people; watch for bloating/gas problems or headaches. Some products contain a higher proportion of soy than others, so be alert to this potential problem - discontinue use if there is a problem. Numbers in parentheses refer to order in list of ingredients, other than water, in product. e.g., (2) means second of the non-water ingredients.
Peptamen:
General Comment Excellent product for PHAs
Fat: Comment
MCT Excellent
Sunflower oil Poor
Carbohydrate: Comment
Maltodextrin(1) Excellent
Sucrose (3) Poor
Corn starch (5)
Protein: Comment
Hydrolyzed whey protein Excellent
Nutren:
General Comment Very good product for PHAs
Fat: Comment
MCT Excellent
Canola oil Excellent
Corn oil Okay
Carbohydrate: Comment
Maltodextrin Excellent
Corn starch Excellent
Corn syrup solids Poor
Protein: Comment
Casein Good
Advera:
General Comment Very good product for PHAs
Fat: Comment
Canola oil Excellent
MCT Excellent
Fish oil Excellent
Carbohydrate: Comment
Hydrolyzed corn starch (1)
Sucrose (3) Poor
Protein: Comment
Hydrolyzed soy Good
Caseinate Good
IsoCal:
General Comment Very good product for PHAs
Fat: Comment
Canola oil Excellent
MCT Excellent
Carbohydrate: Comment
Maltodextrin Excellent
Sucrose (5) Poor
Protein: Comment
Caseinates Good
Soy protein Average
Enercal:
General Comment 'Average' product for PHAs
Fat: Comment
Soy oil Poor
Saff/sunflower Poor
Palm oil Likely okay
Carbohydrate: Comment
Maltodextrin Excellent
Sucrose (2) Very poor
Protein: Comment
Whey protein Good
Soy protein Average
Boost nutritional shake:
General Comment Poor product for PHAs
Fat: Comment
Canola oil Excellent
HO sunflower Excellent
Corn oil Poor
Carbohydrate: Comment
Sucrose (1) Very poor
Corn syrup solids (2) Poor
Protein: Comment
Milk protein Good
Boost nutritional drink:
General Comment Not recommended for PHAs
Fat: Comment
P.H. soy oil Likely poor
Carbohydrate: Comment
Sucrose (1) Very poor
Corn syrup solids (2) Poor
Protein: Comment
Milk protein Good
Ensure:
General Comment Poor product for PHAs
Fat: Comment
HO sunflower Very good
Canola oil Excellent
Corn oil Poor
Carbohydrate: Comment
Corn syrup (1) Very poor
Maltodextrin (2) Very good
Sucrose (3) Very poor
Protein: Comment
Caseinates Good
Soy protein Average
Whey protein Good
HO = high oleic; MCT = medium chain triglycerides P.H. = partially hydrogenated PHA = person living with HIV or AIDS General comment considers mainly the first item of each class of ingredient
In this series:
Disclaimer: The material in this publication is for information purposes only. It does not endorse any particular treatment program nor strategy; neither is it intended as medical advice nor as a replacement for medical advice. ©This document is copyrighted by Chester Myers. All materials may be reprinted and/or distributed without prior permission. However, reprints may not be edited. References Bowen WH, Cornick DE, "The Microbiology of Gingival-Dental Plaque: Recent Findings from Primate Research", Int Dent J 20(1970)382-395. Brouard C, Pascaud M, "Modulation of Rat and Human Lymphocyte Function by n-6 and n-3 Polyunsaturated Fatty Acids and Acetylsalicylic Acid", Ann Nutr Metab 37(1993)146-159. Castro M, Morgenthaler TI, Hoffman OA, Standing JE, Rohrbach MS, Limper AH, "Pneumocystis-carinii Induces the Release of Arachidonic Acid and It s Metabolites from Alveolar Macrophages", Am J Respir Cell Mol Biol 9(1993)73-81. 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February 1997 | |
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Decisions about particular medical treatments should always be made in consultation with a qualified medical practitioner who is knowledgeable about HIV-related illness and the treatments in question. MORE | |