Understanding the relationship between food and medicine has been of interest for centuries. The earliest medicines were derived from plants and animals. Digitalis, used in the treatment of heart conditions, is a medicine derived originally from a plant source -- foxglove. Pharmaceutical grade (pure) medications were developed to standardize both the quality and concentration of a drug in a medicine. Today Western medicine has grown reliant on pharmaceutical technology to produce drugs that will treat many conditions.

In disease treatment we try to impact biochemical pathways (how medications and foods are processed). We "push" a pathway to produce specific chemical endpoint and to affect metabolism. We can also use what is known about the way medicine and nutrients work together to improve effectiveness and allow the use of lower doses -- translating to lower healthcare costs and lower side effects.

However, not all medicines work that way. HIV medications cannot be dose adjusted based on diet. Also, in HIV disease nutrient requirements are affected by the disease itself and the interactions of multiple medications. Still, we can minimize side effects and changes in metabolism with diet and nutrient supplements. Medication effectiveness and potency is increased through improved drug absorption and tolerability and less side effects.

Many of these medicines require nutrients to improve results. For example, in the treatment of diabetes there are many medicines that may control blood sugars and prevent further complications. Proper nutritional intake to correct problems in metabolism and body composition is also necessary. Achieving nutritional health may even erase diabetes completely. However, if a patient does not follow healthful practices, the medicines do not work effectively and the disease progresses.

Some of the diseases that are impacted by the power of food include allergy and food sensitivities, cancer, endocrine disorders, gastrointestinal disease, other infectious diseases besides HIV, hormonal imbalance and neurological disorders. Specific conditions where diet composition are crucial include co-therapies for treating high cholesterol, diabetes, high blood pressure, birth defects, learning disabilities, heart disease, and even Alzheimer's disease. There also is a growing body of evidence that nutritional strategies play a direct role in disease prevention.

Consider that the human body is like a Corvette. Putting diesel fuel into the gas tank should be unthinkable. Similar to a high performance vehicle, our bodies convert food into energy. Foods that contain highly processed sugars and bad fats are "improper" fuel. Our body is unable to convert these foods into energy efficiently. Pathways are diverted to fat storage. Not only does this scenario promote obesity and obesity-related disease, but it also leaves our "gas tank" low on fuel, and we become deficient in energy and nutrients.

Studies show that the standard American diet is sub-standard in basic nutrients -- including vitamins, minerals, anti-oxidants and fiber. Diets are commonly deficient in essential and healing fats and oils, like flax, borage, evening primrose and fish oil. On the other hand, the intake of other nutrients such as simple sugars (table sugar, juices, sodas and white refined starches) and processed hydrogenated or highly saturated fats (fats that are hard at room temperature, such as chicken skin and white fat marbled in meats) is excessive.

In our medical practice we seek to improve the nutritional value of a patient's diet as an adjunct therapy to primary care. Our clinical nutritionists teach strategies to improve disease-reducing complications and medication side effects. Most notable is the impact of nutritional approaches to control diabetes, high blood pressure, high cholesterol, and gastrointestinal or stomach problems. Fatigue, hormonal imbalance and pain management also respond well to a holistic care approach.

Messages to consumers and patients are misleading. Yet the bottom line is simple -- eat wholesome food, including the proper fats and oils. Limit junk food and bad fats.

Perhaps the most important thing for our patients to do is to keep an open mind about the process. Often patients have the idea that they will never have another French fry again. They are frequently surprised by the variety of foods that we recommend including in their diets. (See table below.)

Carla Heiser, M.S. R.D., L.D. and Tom Barrett, M.D. specialize in caring for people with HIV at the Howard Brown Health Center in Chicago, established to serve the city's gay, lesbian, bisexual and transgender community. Visit www.howardbrown.org. Contributing authors Jennifer Zawaski, R.D., L.D. and Emily Lindner, M.D. also work for Howard Brown. Contributing author Judith A Ernst, D.M.Sc., R.D. is an Associate Professor of Nutrition and Dietetics for the School of Health and Rehabilitation Sciences at Indiana University School of Medicine. Heiser is also the president of the Center for Functional Nutrition at Advocate, Illinois Masonic Hospital in Chicago. The authors are on staff at the Center. Visit www.ics.meta-ehealth.com. Online assessment and nutritional intervention is available, as well as recommended supplements.

The following are examples of our medically supervised recommendations.

Overall Nutritional Guidelines (for Non-Vegetarians)

  • Include a quality assured (see below), potent multivitamin and mineral supplement daily

  • Eat natural, whole foods, the less processed, the better

  • Limit simple sugar and refined white carbohydrates

  • Use 100% whole grains in moderate amounts divided over meals and snacks

  • Use lean, hormone-free meats, poultry and eggs

  • Eat cold water fish 3-5 times a week (wild salmon, canned salmon or yellow fin tuna)*

  • Eat plenty of fresh or frozen vegetables

  • Include low-sugar, high-fiber fruits (apples, pears, berries, cherries, citrus)

  • Use teas or coffees that are organic (processed by water, not chemicals)

Nutritional Protocol for Treating Diarrhea and Other Gastrointestinal Side Effects

  • Take out offending foods

  • Eliminate wheat and gluten-containing foods

  • Consider options for replacing cow milk dairy

  • Switch to hormone-free or organic dairy products

  • Consider fortified soy, rice or almond nut milk

  • Add soluble fiber

  • Food sources: ground flax meal, 100% whole grains, legumes, peas and lentils, low-sugar fruits (see above) and vegetables

  • Supplements: Metamucil, Citrucel, Benefiber

  • Drink plenty of hydrating fluids including water and decaffeinated tea

  • Limit, or avoid, caffeine, sodas and alcohol

  • Add probiotics (a blend of acidophilus and bifidobacteria)

  • For severe diarrhea associated with weight loss, use L-glutamine up to 30 g (2 Tbsp. worth) a day in divided doses.**

Nutritional Protocol for Treating High Cholesterol and Triglyceride Levels

  • Limit sugar and refined, white carbohydrates

  • Include the right dietary fats (avoid processing or high heat): flax/borage oil blend -- add to foods or liquids without heating it; cold water fish; olives; avocado; cold-pressed oils (olive, sesame, canola, walnut, sunflower and safflower); raw nuts and seeds; flax meal/oil; raw nut butter (peanut, almond or cashew)

  • Eliminate bad dietary fats: saturated animal fats and hydrogenated (trans) fat (typically found in processed, long shelf-life convenience foods like popcorn, crackers, snack cakes, many salad dressings and margarines, etc.)

  • Improve dietary fiber intake

  • Add quality assured supplements including fish oil, policosanol or non-flush niacin***

  • Improve physical activity

Nutritional Protocol for Enhancing Immune Function

  • Nutrient-rich, whole foods

  • Include the right dietary fats (see above)

  • Eliminate bad dietary fats (see above)

  • Vitamin/mineral/antioxidant supplementation

Nutritional Protocol for Improving Glucose Tolerance and Managing Diabetes

  • Limit sugar and refined, white carbohydrates

  • Include the right dietary fats (see above)

  • Ensure adequate protein and "good fats"

  • Divide meal intake into small portions, eating every 3-4 hours

  • Limit starches at meal based on blood sugar levels before and 2 hours after a meal

  • Include chromium and vanadium supplement with each meal

Quality assured -- look for the Good Manufacturing Practices (GMP) rating on the label, given by the National Nutritional Foods Association (NNFA). NNFA is the oldest and largest non-profit organization dedicated to the natural products industry in the U.S. The "A" rating is given for compliance to rigorous standards. The NNFA's GMP certification program ensures that all elements of the company's manufacturing processes meet specified performance standards of each measure, including quality and disease control, cleanliness and training, receiving and testing of raw materials, and procedures for storage and distribution. "GMP Certified" is different from "GMP compliant." Few companies allocate the financial resources to independently verify that their GMP programs achieve GMP certification.

* Beware of higher mercury levels in other cold-water fish (such as trout, cod and sardines). The wild salmon should be farm-raised from Chile or North America. Don't eat swordfish, King Mackerel or tilefish.

** L-glutamine is expensive and is provided through some public aid formularies. The Houston Buyers Club offers it at a lower price. Once you heal the gut and maintain that with good nutrition, you can lower the dose or cycle on-and-off the glutamine.

*** Non-flush formulation (inositol hexanicotinate) in 500 to 1,000 mg one or two times a day may help avoid flushing. Check with your doctor or pharmacist to see if it's okay to add a baby aspirin before taking niacin to reduce potential side effects. Look for "GMP certified."

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