Protein and Muscle Wasting

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One of the consequences of having HIV infection,or any other infec-tion, is that your body tends to lose muscle.lt happens with cancer, also . from the first day you are infectedwith HIV,this process of muscle wasting occurs. the body actually breaks down its own stores of protein.

Everyone needs a supply of protein each day; the body needs so much that it cannot store enough for the long term. normally, the body manufactures proteins and breaks down proteins on an equal basis (see page 1 1). It appears that cytokines released during HIV infection and other infections change this process, causing more protein to be used up than is made.Itseems irrational for the body to tear itself apart in the face of disease, but there's a reason: it is something we've inherited from our ancestors.

Let's say that one of our caveman relatives was injured while on a hunt and was not found for days.During that time, he had no food. But to heal, the body needs protein; and our body is designed to be self- healing, with the muscle serving as a source ofthat pro- tein.At the same time, the body fat is a reservoir of cal ories that is needed in times of fasting. Thus, the caveman could survive off his own body; using his fat for calories and his muscle for protein. Nowadays, food is plentiful and the supply consistent, so we no longer need to auto-cannibalize to survive.But our caveman physiology has not altered over the years; we still use up body pro-tein when aninfection or injury is present.

To heal, the body needs protein; and our body is designed to be self-healing, with the muscle seruing as a source of that protein.

While muscle wasting can be explained,it is still perplexing. A group of German investigators discovered that people in the early stages of HIV infection begin to show signs of muscle wasting even before they lose weight. You would think that of someone lost muscle weight, surely it would show up on the bathroom scale-unless, of course,something replaced the muscle.In fact, that's what happens; water replaces muscle.

Using a sophisticated device called bioelectrical impedance, the researchers sent a low voltage current through patients'bodies to measure the amounts of muscle, fat, and water. they found that there was a decrease in muscle weight but a proportionate increase inwater weight. the net effect? No change in body weight. only by use of this device are these subtle differences detected. We have conducted a similar study at deaconess hospital and confirmed these findings.It is only after a person develops AIDS that the body fat weight and body weight will begin to decrease. This loss of body fat occurs usually in response to a poor appetite or anorexia (see chapter 1).

Thebest thing you can do to minimize muscle wasting is to eat a diet with twice the usual protein intake and exercise regularly. This won't stop the muscle wasting process completele, but it will slow it down with no added risk to you. On the other hand, if you don't eat enough protein or exercise, the muscles will surely waste fatter.

The combination of a high-protein diet and exercise is vital because muscle wasting (and the loss of organ tissue mass), along with general weight loss, are related to the t ming of death from HIV infection. Dr.Donald kotler and colleagues of new york city found that their patients with AIDS died when muscle and organ mass were 54 percent of normal. Weight loss to 66 percent of normal also resulted in death. This is because the body does not have enough strenght to carry out necessary functions, such as breathing,making blood cell, and even allowing the brain to work properly and orchestrate all of the body's processes.

As we said,we suspect that cytokines are involved in the body's process of destroying its own muscle stores. perhaps the body is iooking for particular proteins to make new white blood cells to fight off the HIV infection. If so, all the more reason to eat a high-protein diet to give your body more than enough of a variety of pro-teins to choose from.

{high-protein foods}

Food	Amount	Approx.Grams Protein
Meat (beef, poultry, veal,pork, lamb, etc.)	1 ounce	7 g
Egg	1	6 g
Cottage cheese (any amount of fat)	1/4 cup	7 g
Milk, soy milk, yogurt (any amount of fat)	1 cup	8 g
Tofu	1/4 pound	7 g
Legumes (peas,chick peas,lentils,soy beans)	1/2 cup	7 g

Your Nutritional Requirements

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1. decide each day how you are going to meet your macronutrient needs (protein,fat, carbohydrates) and spend less time on how you are going to meet your micronutrient needs(vitamins,minerals).
The most severe symptom of malnutririon in people with HIV infection is weight loss and it is related to micronutrient deficiencies not micronutrient deficiencies.Micronutrients supply calories; micronutients do not.This is the most important principle.Give it a high priority and it won't be hard to achive.



2. lgnore advertisements, bulletins, and articles aimed at the general public that trumpet information on healthy eating.
General nutrition information may be fine for most but it is not appropriate for people with HIV infection. it may even distract you form achieving your food goals. very few food are bad for you. sugar is all right (and will not encourage the growth of mouth yeast like thrush). salt is fine, whether it is added at the table or contained in processed foods. red meat,saturated fats, and dairy products are fine and we encourage their consumption. avoid foods that present a contamination rsk, especially raw fish (including sushi), raw meat,and raw eggs; unprocessed honey and maple sugar; and leftover foods more than 2 days old.

3. follow a daiiy meaipian based on tne positive nutrition pyramid.
Resolve to make the following your daily food goals-consume;

* twice the normal amount of protein daily(this means 100 to 120 grams for men, 80 to 100 grams for women; 1pound of meat, poultry, or fish contains about 110 grams of protein)
* At least 2 seruings of fruit(1 piece= 1 seruing) and 3 seruings of uegetables(1/2 cup, cooked or raw= 1 seruing) * At least 2 seruings of milk (8 ounces each)
* Enough other calories from carbohydrate and fat to keep your weight stable.

The first principle of positive nutrition emphasizes the need for macronutrients because calories from carbohydrate and fat are vital for maintaining your weight.


{daily n macronutrient needs}

Calorles	15 to 20 per pound of body weight
Proteln	Men: 100 to 120 grams of protein Women: 80 to 100 grams of protein
Fat	At least 50 grams
Carbohydrates	As much as possible
Flulds	the positiue nutritionplan will provide you adequate fluids, with about half com- ing from beverages, such as milk, juice, and soup, and the other half from solid foods, such as fruits and vegetables. Specifically, you need a 1/2 ounce of fluid per pound of body weight.