Nutritional Management of Lipodystrophy a Simple FactSheet from the AIDS Treatment Data Network

||||| Nutritional Supplements and Dietary Changes:

Nutritionist Donna Tinnerello, RD, MS, HIV Nutritionist at Cabrini Medical Center in New York City, provides some tips for trying to reduce the symptoms associated with lipodystrophy using nutritional supplements and dietary changes. Elevated cholesterol and triglyceride levels have been reported as a side effect of protease inhibitors. The dietary modifications suggested here are backed by research and have been demonstrated over time to work in the general population. Always discuss any nutrition issues you have with your provider. DT: You need carbohydrates, not refined and not simple sugars (carbohydrates are substances in food that can get converted into energy in the body). I tell every one to eat high fiber foods like oatmeal for breakfast - studies show that one cup a day of oatmeal lowers cholesterol nicely. Oatmeal contains soluble fiber that's also found in beans, barley, potatoes, fruits and vegetables. Things like whole wheat, brown rice and other whole grains have mostly insoluble fiber. They are broken down to sugar very slowly therefore they don't raise blood sugars. If blood sugars are normal and dietary fats are kept to a minimum, triglyceride levels should not be higher than normal. Simple sugars like table sugar, regular sodas, fatty desserts, even fruit juices that quickly get broken down to simple sugar should be avoided. People with AIDS should try to eat well cleaned fresh fruit instead of juice. Simple sugars go to the liver, and the liver makes fat out of the sugar - that's one way the triglyceride levels get increased. Complex carbohydrates like whole grains and vegetables (beans) are used slowly, just when we need them for fuel. Complex carbohydrates are a great source of B vitamins, and are of real importance for the health of the nervous system You need some fat. The good ones are monounsaturated like olive oil, canola oil and walnuts. They don't raise total cholesterol and bad cholesterol, but they do raise good cholesterol in normal weight people. They should, however, be used in moderation in people who have high triglycerides. Omega 3 fatty acids found in fish, flaxseed, soybeans and canola oil seem to lower triglycerides. Saturated fat in whole milk dairy products, skin on chicken and turkey and fatty meat are almost guaranteed to raise cholesterol in people on protease inhibitor therapy. When we sleep at night there is an enzyme that kicks in and takes all the saturated fat and makes cholesterol. Too much cholesterol goes to the arteries and causes blockage. You also have to watch out for hydrogenated fat like solid vegetable shortening and margarine. It is not made from saturated fat, but the chemical process that makes it hard at room temperature makes it saturated. Fast food chain French fries and movie popcorn are famous for the use of hydrogenated fat. Eggs are high in cholesterol but research shows that dietary cholesterol from eggs is really poorly absorbed and an egg a day might be okay. Be careful if you are diabetic. Diabetes seems to alter cholesterol transport in the body, potentially making eggs more risky. It's critical to eat enough protein, lean meats, chicken, turkey and lots of fish. Beans are a good source of both protein and fiber. Other good protein foods are all nuts including peanut butter (monounsaturated fat) and soy products. Skim milk dairy products are another source of protein. It's good to eat lots of vegetables and fruits. They are loaded with vitamins, minerals, antioxidants, phytochemicals and fiber that all have an important role in a healthy diet. Try to eat fruits and vegetables in a variety of colors every day so you don't miss out on any of the nutrients. There is antioxidant power in all those colors. Exercise is very good. Aerobic exercise 45-60 minutes a day. Power walking, treadmill, biking or roller blading are good aerobic workouts that are good for lowering blood sugars and blood lipids. Everyday exercise increases insulin sensitivity (helps sugar processing) by as much as 30%. Resistance exercise is better for building muscle mass and preventing muscle loss. While in most cases of lipodystrophy overall weight loss may not be desirable, there might still be an improvement in sugar processing (insulin sensitivity) if the fat round the waist can be reduced through exercise. A good multivitamin with mineral supplement is basic for people with HIV. A high antioxidant formula is even better. The antioxidants are good for HIV and are a preventative therapy for heart disease and cancer. Taking separate supplements is troublesome and confusing when one supplement can include everything. The idea that these supplements may reduce the symptoms of lipodystrophy is based on what's known about how they work in the body. No research studies have been done, but individual stories suggest they might sometimes be able to help. L-carnitine 2 grams/day helps the body to increase fat burning in the cells. This could help to lower triglycerides. It also seems to be helpful in preventing neuropathy associated with the "d" drugs like didanosine (ddI,Videx) and stavudine (d4T, Zerit). L-carnitine is available as the prescription drug Carnitor. NAC at 2000-4000mg/day may be useful for the acquisition of lean body mass and the prevention of lipodystrophy. Seems to be especially effective in combination with anabolic steroids or growth hormone (muscle building drugs). NAC is a precursor of glutathione, an antioxidant that works with insulin to manage blood sugar levels. Chromium is involved in the body's processing of carbohydrates and fats. No studies in people with HIV but studies in non-insulin dependent diabetics indicate that doses from 200-1000 mcg are effective and safe. It may increase sensitivity to insulin by 40% and may help to reduce the risk of diabetes. Niacin is one of the B vitamins that seems to work with chromium to reduce diabetes risk and independently to help lower cholesterol. You should not take a separate niacin supplement, however, but a B vitamin complex that includes niacin. It is always wise to take a B complex 25-50 supplement rather than single B vitamins. The B vitamins as a group are referred to as the stress vitamins. An important reason to take the Bs is to prevent neuropathy (nerve damage) and stress. Some B vitamins are also protective against heart disease. Alpha lipoic acid (also known as thioctic acid) plays a role in sugar processing. It seems to increase the muscle permeability to glucose thus helping to spare insulin. There is less pressure for insulin to do all the work. Insulin insensitivity and glucose intolerance seems to be one of the causes of lipodystrophy. Alpha lipoic acid is also used for treatment of both diabetic neuropathy and HIV peripheral neuropathy. Omega 3 supplements 2-3 grams/day helps to lower triglycerides. If you don't like fish, omega 3 is also available in flaxseed, flaxseed oil pills (2 grams/day) or ground flaxseeds (1-2 tablespoons/day). Caution: don't use these supplements (both fish oil and flaxseed oil) if you have low platelets, as omega 3 is a blood thinner. You have to be careful with other blood thinners too like vitamin E (high dose), garlic, gingko biloba, feverfew, aspirin, ginger and prescription blood-thinning drugs like Coumadin. Supplements can be expensive, but some vitamins, minerals and nutritional supplements are covered by ADAP (the AIDS Drug Assistance Program) and Medicaid. Call the Network at (800) 734-7104 if you need to find out which supplements are available through these programs. 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