Inter-Q-Zone

The Nutriton Access Project's
Guide to Healthful Living for People with HIV
by Halley Low
for the Nutrition Access Project
sponsored by
The Healing Well

This Work is dedicated to the living memory of
John J. Jordan, J.D.
and
Alex Konski

The Nutrition Access Project is a program of The Healing Well. The project's mission is to facilitate the dissemination of vital nutritional information into the hands of those who need it most, namely people with HIV or other life-challenging conditions. This booklet was designed with the intention that this important life-enhancing information be available to all. This booklet is NOT FOR SALE. You can assist in this important task by making as many copies of this booklet as you can and giving them to those who need it. Your help in this regard is invaluable as this project is a grass-roots program with no money, only the caring hearts and helping hands of those who agree this information can make a positive difference in their life and the lives of others. Our thanks to the nameless who are assisting in spreading the word.

TABLE OF CONTENTS

INTRODUCTION

Nutrition is basic to life. All living organism require food (fuel) in order to function and grow. Proper nutrition is thus necessary for optimal health, for people with HIV this is even more crucial. This booklet will explore the reasons why nutrition is of particular importance to people with HIV, as well as give practice advice on how to be sure that you are getting the nutrition you need.

The purpose of this work is to inform and empower people about and through nutrition. Many HIV experts recognize that a HIGH PROTEIN/HIGH CALORIE DIET can help you live a healthier and longer life. This booklet was designed to help get this message out to as many people as possible, therefore it is not to be sold and you may copy and distribute it to has many people as you can.

Special thanks to Mary Romeyn, MD of San Francisco for her guidance and encouragement. Much of this booklet is informed by her work, and the work of other clinicians and researchers in the field of nutrition, including those wonderful nutritionists at GMHC. For a more comprehensive understanding of the role of nutrition in HIV infection please read Dr. Romeyn's book - Nutrition and HIV (A New Model for Treatment) available at most book stores. Also I must thank the Staten Island AIDS Task Force for the use of their computer and support.

TREATMENT MODELS FOR HIV

When HIV was identified it was first seen as an infection of the immune system. Therefore, the first treatment model was the immunological model. The primary focus of this model is to attack HIV directly and improve or restore proper immune function.

The second model is the Infectious Disease model. Here HIV is viewed as an illness of opportunistic infections (infections that would not affect someone with a normal functioning immune system, but take the opportunity to affect someone whose immune system is deficient). This model treats or prevents opportunistic infections.

The third model is Nutritional. We now know that HIV is also an illness of nutritional deficits. Early in the course of infection HIV begins to change the structure and function of the cells that line the intestinal wall (gut). These changes effect the absorption of nutrients. This process along with other changes caused by HIV result in nutritional deficits that may cause or exacerbate symptoms. Most important is "wasting" syndrome or HIV-related weight loss. The nutritional model directly addresses wasting, nutritional deficits, and serves as a support to the two previously mentioned models. It is important to understand that the nutritional model does not replace the two previous models, but works well with them.

HOW HIV AFFECTS YOUR NUTRITIONAL STATUS

Studies have shown that people with HIV tend to eat less than people who are HIV negative. This process appears to begin early in the infection. Often it is subtle and may go unnoticed. Therefore, it is important to monitor your food intake and be aware of how much you eat. Intake is the first step in getting the nutrients you need. If you are not eating enough it will be more difficult for your body to get the nutrients it needs, as well as calories (units of energy).

As mentioned before, HIV changes the structure and function of the cells that line the gut. These changes result in changes in nutrient absorption (the process of extracting nutrients from food and transferring them into the blood which occurs primarily in the small intestines). We call this improper digestive process - malabsorption. Malabsorption is a primary cause of nutrient deficiencies. Extra nutrients in the form of supplements may help to compensate for this process.

Another aspect of HIV's interference in your nutritional status involves the metabolism of nutrients. This is a complex body process. The changes in this process result in the following: nutrients are inappropriately converted into fat in the liver, fats are stored preferentially instead of being converted into energy, energy needs are met by sugars, when sugars are gone the body converts proteins into energy, this protein is taken from your lean body mass (muscle), the liver continues to make fats in preference to proteins so that lost protein is not replaced. This process is greatly increased in the present of an active secondary infection.

Finally there are changes in the metabolic rate. These changes reflect the way energy is used by the body. People with HIV will expend more energy while resting, the body will compensate for this by reducing the energy spent during activity. This change is partly responsible for fatigue and lethargy. This process is greater in persons with active secondary infection.

All of these changes can result in changes in your overall nutritional status. Many studies have shown that people with HIV have a tendency toward certain vitamin and mineral deficiencies. Among the most common are: vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B6 (pyridoxine), vitamin B12 (cobalamin), folate, magnesium, selenium, and zinc. Nutrient deficiencies may cause or exacerbate symptoms such as neuropathy, myelopathy, fatigue, depression, skin rashes, diarrhea, etc.. The immune system itself relies on certain nutrients in order to function properly. For people living with an immune system that is already impaired poor nutritional status will only serve to put more stress onto an already stressed system. Nutritional supplements can be of great benefit. Recommendations for appropriate supplementation are given in this booklet. However, for appropriate assessment of your nutritional status and your individualized nutritional and protein needs, we highly recommend consultation with a doctor knowledgeable about the nutritional aspects of HIV and/or a nutritionist experienced in working with people with HIV.

WASTING

The changes in intake, absorption, metabolic rate, and the metabolism of nutrients, play an important role in the process known as "wasting" or HIV-related weight loss. It is important to understand the different between wasting and normal weight loss, and why it is so crucial to the health and well-being of people living with HIV.

In normal weight loss, such as in dieting, one reduces caloric intake forcing the body to relies on fat reserves for energy. Thus the result is that the dieter will loss fat and be thinner. In HIV-related weight loss or wasting, a comletely different process is occurring. As stated before, changes in the metabolism of nutrients that occur in people with HIV cause the body to save fat and use protein stores (muscles) for energy. What this is saying is that a person who is HIV+ and losing weight is losing muscle not fat. It is not good to loss muscle (lean body mass). Muscle is what keeps us strong and healthy. Loosing muscle makes us weak. We know that most people who die of AIDS in fact have died from wasting. When we reach the point of 54% loss of lean body mass we die. This is what happens if a person is trapped on an island with no food. They we live till they reach this point of muscle loss and then die. With HIV it is a starvation from within. Besides the changes in nutrient metabolism, reduction in intake of food and malabsorption further the wasting process. Secondary infections and diarrhea further exacerbate the situation. Therefore, it is important for you to understand the wasting proess and more importantly to understand that there are things you can do in your everyday life that can prevent or postpone or reverse the wasting process. This is not just pretty words, you can make choices and perform actions that will directly benefit your health and life - to quote the Power Rangers "the power is in you".

CHOICES AND ACTIONS

As stated above there are choices and actions that you can make today that will directly benefit your well-being. Economics, emotions, physical strength, support systems, knowledge, and beliefs, are among the factors that may influence the choices and actions you make and take. The suggestions in this booklet are not meant to create stress in your life, they are not laws you must follow. These suggestions are meant to give you practical guidance to living a healthier, happier and longer life. The important thing is to start where you are at, and to do what you can. This means caring about yourself to take the measures you can in your daily lfe to make it better, whether that means snacking on salted nuts for extra protein or having fresh flowers on your table. It also means learning your limitations and accepting them, and asking for help when you need it.

A good place to begin would be by assessing your daily food intake. Keep a dietary diary for three weeks. In a notebook jot down what you eat and how much each day. Better yet tape a piece of paper on the frig door and mark down what you are taking in right after you finish and before you forget. This will help you assess how many calories and what kind of nourishment you are getting.

It would be wise to enlist the aid of your doctor and/or nutritionist in gaining an understanding of your particular nutritional status and needs. There are methods by which your doctor and nutritionist can determine what your percentage of lean body mass is in comparison to your overall weight. This is important because just knowing your weight by standar means can be deceptive. Remember it's your lean body mass that is important. This can be ascertained by two methods. Anthropometry is a method used by dietitians. It works by measuring certain parts of your body and using those measurements to estimate how much of your weight is fat and how much is muscle. Impedance monitors are a more reliable measure of lean body mass. It works by sending a low level electric current through your body. Electricity flows through fat at a different rate than it does through muscle, observing that different determines your fat-to-lean ratio. The process is absolutely painless and only takes a minute.

Enlisting the aid of your doctor or nutritionist is more than just getting your lean body mass measurements. Your doctor can order blood works that are necessary to evaluate your nutritional status. Your doctor or nutritionist should be able to recommend appropriate diet and supplementation. Not all doctors or nutritionists are experienced with HIV. If yours isn't you might consider findng one who is, or if you have a good relationship with your health professional than you should consider your role as educator to the doctor. This is a radical concept for many of us, particularly the doctors out there who might be reading this. The fact is that the body of knowledge of HIV is growing. It is impossible for any one person to be aware of all the information out there, particularly if it is not their specialty. Even if it is their specialty, their knowledge of nutrition in regards HIV may be inadequate. As the person who is receiving care you of course wish to receive the best care, given the realities mentioned, you may well benefit by educating yourself and passing that information onto your healthcare provider. When passing on information it would be wise to bring a copy of the article or study that is about what you wish to share. Doctors pay more attention to written materials and will respect your opinions more if they see they are informed. Remember, yo are not an expert either, the goal here is to work together for your benefit, and not to alienate your doctor or set yourself up as the "authority".

HIGH CALORIE/HIGH PROTEIN DIET

As a general rule people with HIV need to eat a HIGH CALORIE/HIGH PROTEIN diet. Changes in your metabolism may increase your caloric need. Decreased intake (not eating enough), malabsorption and diarrhea can reduce calories and nutrients available for your body's use. Not enough calories means not enough energy for your body to function. Not enough protein in your diet exacerbates the loss of lean body mass (muscle). Not enough nutrients can lead to nutritional deficiencies that may result in symptoms like skin rashes, or nueropathy, or fatigue (to name a few), and impede immune functioning. Thus to keep your body supplied with the building blocks it needs to stay strong and function best, it is crucial that you eat plenty of protein and calories. Your doctor or nutritionist can help you determine what your indvidual caloric and protein needs are, or you can do the calculations in the appendix.

HIGH CALORIE DIET

A high calorie diet should include a wide variety of foods. Some foods are packed with calories like carbohydrates, meat, and fats. Including these foods in your diet can help you increase your caloric intake.

Carbohydrates are a good source of energy (calories). There are basically two types of carbos - complex and simple. Both are good sources of calories. Complex carbohydrates contain additional nutrients. Some examples are: oatmeal, whole grain breads, and brown rice (energy and protein). Some examples of simple carbohydrates are: brown or white sugar, honey, jams and jellies. You can increase your caloric intake simply by adding some of these to your food. If you like to eat fresh fruit (excellent source of vitamins and minerals, but low in calories) you can increase its caloric value by dipping slices of fruit in honey. This is a delicious way to eat fruit! In the morning when you have your buttered toast or bagel consider adding jam or jelly to boost calories and give you quick energy, peanutbutter will also add calories plus protein. Adding a tablespoon or two of honey to your glass of water or milk makes them a special treat. Sprinkle wheat germ on your cereal or yogurt. Add oatmeal to your meatloaf and you get a triple benefit - extra calories, extra nutrient, and extra flavor. Don't forget to add plenty of croutons to your salad.

Fats are also calorie rich foods. So enjoy butter and/or sour cream on your potato, and drink whole milk (adding powdered milk to it will boost its protein). Be aware though that fat can be problematic. Foods rich in fat often are low in other nutrients. Fats can cause you to feel full and thus not eat all you should. Some people with HIV develop fat intolerance, consuming fats can cause or exacerbate diarrhea. Many experts in the field of HIV and nutrition agree that the best diet or people with HIV is a high calorie, high protein, low fat diet. So instead of piling mayo on your sandwich to boost calories add extra meat or cheese. Meat and cheese are high in calories as well as protein. Instead of snacking on fat laded and nutition-free foods like potato chips enjoy salted, honeyed, or smoked nuts. Nuts are delicious, high in fat but also an excellent source of protein. Another idea, instead of extra butter or sour cream on your potato try adding grated cheddar or your favorite cheese. As stated before, cheese is high in calories and protein, so it is a wiser choice than plain butter. We are not saying you shouldn't eat fat, just be aware that some foods are better choices than others. All fats are not equal, the fact is that some are better than others. Choose monounsaturated fats like, olive oil, canola oil, soybean or peanut oil. Olive and peanut oils add flavor to cooking and salads. If strong flavors or odors bother you (some people with HIV develop sensitivities to certain tastes or odors) then use canola oil which is completely tasteless and odorless.

PROTEIN, PROTEIN, PROTEIN

The importance of protein can not be overstated. Protein is the building blocks of the human body. The immune system requires protein to function properly. Our lean body mass or muscle is protein. In HIV infection when we lose protein we are losing muscle. A high protein diet coupled with a light anabolic (muscle-building) exercise program can help to prevent the lose of muscle, and build up a protein store for later.

How much protein do you need a day? That can be determined by doing the calculations for caloric/protein needs in the appendix, or by consulting with your doctor or nutritionist. In order to keep easy track of your daily protein intake, Dr. Romeyn recommends assigning the following average values to particular foods.

Using this system allows you to keep track of your protein intake in a simple and easy to use manner.

Some good and inexpensive sources of protein are: eggs, beans, peas, tofu, oatmeal, milk, and some cheeses. Of special note are egg whites. Egg whites are pure high-quality protein, minus the yolk they have a delicate taste and are easy to digest. Add egg whites to other foods to increase their protein value. A good example: when making canned chicken noodle soup, lightly beat an egg white and stir into soup while cooking. Recipes for delicious protein rich dishes are given in the appendix.

POSSIBLE OBSTACLES TO EATING

Some people with HIV may experience a decrease in appetite or limit their food intake because of discomfort. Someone who has sores in their mouth, or has oral thrush, or has a sore throat, may find the act of swallowing painful. If it hurts to eat one may opt not to eat. If swallowing is painful you may find it easier to eat cold foods that numb the mouth and throat. You may find it easier to eat soft foods as well. Good examples are yogurt, ice cream, cold soups, vegetable or fruit purees, mashed potatoes with melted cheese, pasta salads, egg salad, humus, pate,, cottage cheese, and custard.

Some people with HIV may develop lactose intolerance, an inability to digest dairy products. This can cause cramps or bloating or diarrhea. If this is a problem for you there are a couple of things you can do. Either avoid milk products or use commercial products that assist in the digestion of lactose.

Some people may limit food intake if they have chronic diarrhea that is triggered by eating. However understandable, it is not a good idea as that will only exacerbate wasting. Again there are things you can do. If you are taking a anti-diarrhea medicine consider taking it shortly before eating. There are also foods that help combat diarrhea like, oatmeal, white rice, pasta, cooked carrots, stringbeans, sweet or white potatoes, applesauce, bananas, peeled apples and pears. Good protein sources are skinless chicken, baked fish, tofu (soybean curd), and scrambled or boiled eggs.

Depression can also cause us not to eat. If you feel low or lonely or don't care its hard to have an interest in eating. Certain nutrient deficiencies can lead to depression or become part of the cycle. We know if we don't eat we get weak, so depression can have a very negative effect on both our physical health and our quality of life.

It's important to get help for depression as soon as you recognize it. Support groups are very beneficial for many. Being in a safe place and sharing with people who understand can help make tough times more bearable, and even renew a sense of communion and peace. Some times we need to talk one on one with a counselor. Some times we may need treatment with medication or specific nutritional supplement. Do whatever you need to do to appropriately address depression in your case. But don't wait, talk with your doctor or a friend, let them know what you are feeling, reach out.

A great place to eat whether you are lonely or depressed or not are the dinner programs that different places host for people with HIV. Check with your local AIDS service organization for locations in your community. This is a fun way to make new friends and eat nutritious food. Often we enjoy eating more if we are sharing food with others. This can not be under-estimated, food like life is meant to be enjoyed.

If you are home bound you may want to check with your local AIDS service provider about meal programs that deliver. Many areas have such programs and they can be a blessing. If you are homeless often it can be arranged to have your meal delivered to a pre-arranged street corner. In New York we have God's Love We Deliver, in San Francisco we have Project Open Hand, both are excellent programs. Contact your local AIDS provider to find out about programs in your community.

SUPPLEMENTATION

Changes that HIV makes in the digestive processes can lead to nutrient deficiencies that can have negative effects on our bodies. Not enough zinc can impair immune response. Not enough folate can cause pain in the mouth or tongue. Not enough vitamin B12 can lead to neuropathy or myelopathy. Not enough vitamin B6 can cause depression or skin rash. Thus nutrient deficits can negatively impact on our health and quality of life.

To avoid deficiencies and associated problems it is recommended by many doctors and nutritionists to take vitamin/mineral supplementation. Simply taking a multivitamin tablet (without iron) twice a day (one with breakfast, one with dinner) can help to avoid frank deficiencies. Remember, it is wise to take your supplements with food to aid in absorption. Good vitamins are available at reasonable prices through buyers clubs like Direct AIDS Alternative Information Resources (DAAIR) in New York.

To know your particular supplement need will require the cooperation of your doctor and nutritionist along with some blood work. Dr. Romeyn offers these general recommendations. Though imprecise they are a good start, and take into account the dangers of over-supplementation.

NOTE ON ANTIOXIDANTS

In order to function the cells of our bodies must produce energy. During this natural process molecular by-products occur called free radicals. Free radicals are oxygen molecules that are missing a electron. There presence disrupts cellular activity and can damage the cell structure. In the presence of active infection, this process is greatly increased. Antioxidants are chemical substances that make free radicals back into normal oxygen molecules. There is much talk about antioxidants these days. Among the most popular are vitamin C, vitamin E, and vitamin A. A thorough review of the uses and benefits of antioxidants is beyond the scope o this booklet. We recommend you investigate their use further. Below are some interesting facts about antioxidants:

EXERCISE

Exercise, like good eating, is basic to life. For people with HIV exercise can be an excellent way to stay healthy and fight wasting, fatigue, and depression. Physical activity gets the heart pumping, wakes up the body, clears the mind, and calms the emotions.

Of particular importance to us, is the role of exercise in preventing or reversing the wasting proces. When we build muscle we are building up protein stores and making ourselves stronger. Anabolic (muscle building) exercise is of great benefit to us. Any resistive exercise is good - weight lifting, isometrics, calisthenics.

The key is to do what you can. Don't push yourself to much, just a little will do you a world of good. Maybe join a gym, or get yourself an exercise partner, that way you,ll have more fun and encouragement. Check with your local AIDS service provider to find out about exercise groups in your area.

SAFER FOOD

Food borne germs are a problem that needs to be addressed. How you pick, store, and prepare your food is very important. When choosing fresh fruit or vegetables avoid any that are bruised. Wash fruit and vegetables thoroughly, preferably soak them in a sink full of water with a teaspoon of iodine added. This will minimize any surface bacteria.

Keep meat away from other groceries. Freeze meat that you are not using that day. In the refrigerator store meat on the bottom shelf, so that if any juices leak out they will not contaminate other foods. Remember, raw meat is an excellent breeding ground for germs, so cook well. Never put cooked meat back on a platter where there was raw meat, unless the platter has been washed first.

Keep cooking surfaces clean. Wash counters, table, and sink with bleach and water for effective germ control. Any food that has been sitting in your refrigerator for more than a couple of days should be thrown out. Do not eat bread with mold on it.

Be ware of foods that have been out to long. Deli foods are of particular note. Salad bars can also be a problem if the food is not fresh. Germs love room-temperature air exposed foods. Following these simple steps can help you avoid food borne illness.

Note on Water - Water is an essential nutrient. Drink plenty daily (8 to 10 glasses), particularly if you are on certain medications like Crixivan. But remember water can hold germs and parasites like crypto, so only drink bottled spring waters like Naya or any brand that filters to one mirco. Safest yet is bottled distilled water. If you drink tap please be sure to boil it for five minutes first. You can bottle it and keep in frig to be cold and handy.

BEING GOOD TO YOURSELF

It is important to remember that life is meant to be enjoyed. HIV can cause many changes in your life. It's normal to at times feel angry or depressed. But unchecked angry or depression can rob us of the pleasures of life we still have or may develop. Support groups can be of great benefit in releasing anger or dealing with depression. Remember a support group is not some thing you have to do, but a support group can be something good you choose to do for yourself.

Don't be afraid to do things you like for yourself. Spend some time everyday doing things that you enjoy. Touch base with people you care about everyday, even if its only a phone call. Its important to stay in touch with life and other people help us to re-affirm that connection.

Dr. Romeyn is a believer in comfort food. "Comfort food are those foods that have strong emotional appeal. If you enjoy eating corn dogs because it reminds you of the country fairs you attended in your youth, you are eating a "comfort food. When I am ill I love to console myself with orange juice and Italian sesame cookies. I'm not even sure why, but I always feel better when I eat them. Some times when no other food appeals to you, comfort foods still may, so always keep some of your favorites on hand."

SUMMARY

Nutrition can help you live a healthier and longer life. Considerable evidence exist to demonstrate the benefits of a high protein/high calorie diet for people with HIV. The nutritional approach addresses many needs for people with HIV while serving as a support to other medical or alternative treatments. Simple, pleasurable choices can be made in your daily life that can prevent or counteract the wasting process, thus prolonging life. Recognize the power in your own hands. Find a knowledgeable doctor or nutritionist to work with. Allow yourself to feel good about yourself. Use the information presented here to improve your life, and share it with others. Be wise. Be well. Live free.

Caloric/Protein appendix

- for women

Take your weight multiplied by 4.4 and add it to your height, add that to the number of inches over 5 feet multiplied by 4, and add that to the number 910 and you have your first subtotal. Now take your age and multiply it by 4.7, and subtract it from the first subtotal and you will have your second subtotal. Now choose one Activity Level -

Protein need
for maintenance take number for caloric needs and multiply by .031, and that amount is the number of grams you need.
for anabolism (repletion) take number for caloric needs and multiply by .042 and that is what you need.

- for men

Take your weight multiplied by 6.2 and add it to your height, add that to the number of inches over 5 feet multiplied by 12.5, and add that to the number 816 and you have your first subtotal. Now take your age and multiply it by 6.8, and subtract it from the first subtotal and you will have your second subtotal. Now choose one Activity Level -

Protein need
for maintenance take number for caloric needs and multiply by .031, and that amount is the number of grams you need.
for anabolism (repletion) take number for caloric needs and multiply by .042 and that is what you need.

RECIPE APPENDIX

Here are a few delicious high protein/high calorie recipes. All are quick and easy to prepare.

Italian Bean Soup
(From my Grandmother's kitchen. Vegans may substitute additional water in place of chicken broth. Freeze extra in small containers for easy use.)

In a large soup pot pour in enough olive oil to lightly cover bottom. Place on high heat and saute onion and garlic til slightly transluesent. Pour in broth, water, and crushed tomatoes and stir. Let liquid get hot but do not bring to boil. Add carrots, celery and potatoes, basil and oregano, stir, cover and lower heat. Stirring occasionally allow to simmer for 1 hour. Then add beans, fresh parsley, salt and pepper, stir, cover, and allow to simmer on very low heat for additional 20 to 30 mins.. Serve hot with whole wheat bread and butter.

Super Protein Meatloaf
(A protein packed meatloaf that is easy to prepare and deliciously different.)

Place ground beef in large mixing bowl. Add oatmeal, whole egg and whites, mix well with hands. Add grated onion and other seasonings and mix well. Turn out onto a baking pan and shape into a loaf. Bake in a pre-heated oven at 350 about 1 hour or until cooked through to center. Place on platter and pour gravy over.

Pasta with Tofu
(Tofu is an inexpensive protein source. Cooked in this sauce it taste like mozzeralla.)

In a large sauce pan pour in enough olive oil to lightly cover bottom. Saute onions and garlic til transluecent. Pour in crushed or puree tomatoes and water, and lower heat. Add herbs, salt, and sugar, stirring occasionally, cover and simmer on low heat for 1 hour. Add tofu and broccoli, stir and simmer another 10 - 15 minutes. Ladle over drained pasta, toss and serve. Sprinkle with grated cheese.

Upper Crust Tuna Salad
(Like no other tuna salad you have ever had. High calorie, and good enough for guests.)

Mix all ingredinents in a medium-sized bowl. If you like a little tang use spanish green olives instead of black. To increase protein value add 1 chopped hard-boiled egg. Chill. Serve on bed of lettuce or spinash, on toast or Italian bread, or mixed with pasta.

BLENDER DRINKS
An easy way to get fresh fruit in your diet, or to create home-made high protein drinks.

Tropical Delight
(One of my very favorite. Great straight or over ice. Can serve as an exotic dessert, nutrient rich breakfast, or refreshing snack. High is vitamins C and A, potassium, and calories.)

Place all ingredinents in blender. Blend on high for one minute. Makes 2 servings.

Pear-nana
(Creamy with a little zing, easy to digest, great if diarrhea is a problem.)

Place all in blender. Blend on high for one minte.

Ouick & Easy High Protein Drink
(Cheaper and better tasting then commercially prepared products.)

Place all in blender. Blend on high for one minute.

Aunt Esther's Sour Cream and Banana Treat
(High calorie and yummy, this will make you FAT but not reccommended for daily consumption.)

Slice banana into a small bowl. Mix in sour cream and sugar. Chill.

Halley's Nouveau Version
(A healthier adaptation, just as yummy, and recommended for daily consumption.)

Slice banana into a small bowl. Mix in yogurt and honey. Sprinkle with blueberries and/or chopped nuts, if desired.

Mexican Avocado Dip
(This i a simple recipe that takes virtually no time to make. It's great for snacking with chips or crackers and cheese, or as a condiment for sandwiches. Nutritious and high calories.)

Mash avocado in bowl with a fork. Mash in the garlic clove. When nicely pureed mix in salt and lime juice. If you want a little zing add the cayenne. Chill.

LIST OF IMPORTANT NUMBERS FOR HELP OR INFORMATION

The Healing Well - 1 718 727 2752
Spiritual counseling, nutrition/health education

Project Inform National Hotline - 1 800 822 7422
Treatment info and referrals, caring phone counselors

AIDS Treatment Data Network - 1 800 734 7104
Up to date treatment information and education

National Minority AIDS Council - 1 202 483 6622
In formation and advocacy

God's Love We Deliver - 1 212 294 8100
Food for homebound PWAs

Direct AIDS Alternative Info Resources - 1 212 725 6994
Information and buyer's club, lowest prices nationally for supplements

PWA Health Group - 1 212 255 0520
Unapproved drugs, treatment education, advocacy

Community Prescription Service - 1 800 842 0502
HIV + owned and operated, national mail-order service (for medicine)

CDC National Hotline - 1 800 324 2437
Information and referrals nationally

Gay Men's Health Crisis (GMHC) - 1 212 807 6664
Client services, nutritional counseling

PWA Coalition - 1 800 828 3280
Information and advocacy

Staten Island AIDS Task Force, HIV Resource Room - 1 718 448 8802
Treatment information, referrals, crisis counseling

On the WEB? Check out - www.aisnyc.org
with links to many AIDS organizations.

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copyright © 1997 Healing Well
Last modified: 7/15/97

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