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Q: Wasting Syndrome
What are the options, including current treatments, to deal with wasting syndrome related to HIV infection?
A: Ken Stringer (Website Administrator) responds:
"Waste not, want not." That's what Jennifer liked to say. She considered prevention of the wasting syndrome to be one of her paramount goals as an HIV-savvy nutritionist. And she dealt with it in many of her articles in one way or another. In particular, Looking Great for 98! is a good place to start. And, since malabsorption of food is a major obstacle to maintaining or increasing body weight, her articles on how to combat such things as diarrhea and nausea are also very pertinent. See Shit (Still) Happens, Hurl Not, and Gut Ecology. Pyramid Power and Appetite Control also contain very relevant information. In truth, since wasting is so intimately a function of nutrition, it would be hard to find an article of Jennifer's that didn't somehow touch on this subject.
Charlie Smigelski, RD responds:
If you are worried about Wasting, prevention is really important. And then early treatment .
Here is a list of nutriton steps to check...1. Are you eating all the nutrients you need?
A) You need 17 calories for every pound you weigh. So 160lb person needs 2720 calories a day. This is significant; it works out to be something like 900 a meal. Cereal, toast, milk, coffee, a banana, and a muffin add up to 750..... coffee and a bagel might just be 450. Are you already 200-300 calories behind and it's not even lunch yet?
B) You need 3/4 gram of protein for every pound of ideal body weight. If you are 5'8" and weight 160, then 120 grams of protein is your goal. If you are 5'8" and weigh 190, (and the extra weight is not rock hard muscle), 120 grams is still your goal; if you are a muscled hunk at 190, 143 grams is your protein need. While starches and vegetables provide some protein, you need soy powder, whey protein powder, or fish, fowl, and land animals for major protein doses. A 12oz hunk of salmon gives you 84 grams of protein. A cup of yogurt only 8 or 9.
2. So you eat like a champ and still are losing weight, then we have to consider malabsorption. Nearly 47% of people with HIV have some amount of D-xylose (carbohydrate) malabsorption, and about 15% have fat malabsorption. Micronutrient malabsorption of elements like zinc, copper, and chromium also exists, but is less clearly documented. So you need to be sure your gut cells are working at their best. L-glutamine is the amino acid that helps keep gut cells nourished. If you are suspecting you are wasting, you might want to be taking 20-30 grams of L-glutamine a day. Otherwise, 5-10 grams a day to keep gut cells nourished and prevent wasting is fine. Gut cells have a way of getting the glutamine they need when they are stressed, like from the toxicity of protease inhibitors. The trouble is, they get their glutamine from arm and leg muscles! By the way, the other amino acid that helps glutamine in muscles is N-acetylcysteine: 2 grams a day,(NAC). So supplementing with 5-10 grams of glutamine every day is a way to keep muscles and gut cells happy.
3. Hormone levels in the body, especially testoterone, can fall low, and prevent proper muscle repair. So wasting can be about low hormone levels. Even when testosterone levels are raised with shots or patches, some people don't re-grow lean body mass. They might start to use anabolic agents, like decadurabolin shots, oxandrin pills, or growth hormone shots. These agents are medicines, and all medicines have a positive and negative side. One's own medical situation is the determinant of when the benefits out-weigh the risks. A good source of information on anabolic therapy is the www.medibolics.com web site.
4. Some doctors refer to a "metabolic block" that prevents reversal of wasting. A few studies have shown that intense resistance training exercise (also known as weight-lifting) can overcome the block. This means working out 3 times a week, lifting weights at 75% "one rep max". Ask a trainer to help you figure out what this weight level is for you.
CONCLUSON: Start with great nutriton. Get all the protein and calories you need. Of course you are taking all the anti-oxidants like selenium, vit C, vit E, and beta carotene you need. If you are worried about wasting that is happening, or just want to prevent it, then add some specialty amino acids. This will go long way to preventing or reversing wasting.
Chester Myers, PhD, MS responds:
I think the information in Jennifer's referenced articles and Charlie's response above is perhaps about all that can reasonably be said on wasting. A more detailed answer would depend on whether its presence is being observed in the absence or presence of the protease inhibitor treatments, and in the case of the latter, whether it was already starting before. Wasting usually means weight loss (a great misfortune, since metabolic wasting, the precursor to weight loss, is where we should be focusing). Weight loss, as such, could be from diarrhea that accompanies certain drug treatments. As baseline, the person should make sure they are supplementing at least with vitamins, minerals, NAC and glutamine. In addition to Jennifer's articles and Charlie's answer above, you'll find more on this subject as you peruse other Q&As on this website.
