stristrive to thrive ve to thrive - nelson vergel · stristrive to thrive ve to thrive ......
TRANSCRIPT
10/30/2010
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Copyright © 2010 by Nelson Vergel
Nelson VergelProgram for Wellness Restoration
Strive To Thrive Strive To Thrive While Growing Older With HIVWhile Growing Older With HIV
AgendaAgenda
nn Best supplementsBest supplements
nn Protecting the heartProtecting the heart
nn Treating erectile dysfunctionTreating erectile dysfunction
nn How to manage fatigueHow to manage fatigue
nn Nutrition as medicineNutrition as medicine
nn Exercise, the best therapyExercise, the best therapy
nn Questions and answersQuestions and answers
Population over 60 years of age
2000 2025 2050
Total world population
2
4
6
8
10
0
Po
pu
lati
on
(Bil
lio
n)
10%15%
22%
4%
2015
25%
60%German HIV+
> 60 years of age
HIV, HAART and aging: a rough estimateHIV, HAART and aging: a rough estimate The Cost of “Pretty”The Cost of “Pretty”
Bottox: $100/mo
Buttock Implants$5,000-$12,000
Cialis: $120/mo
TRIMIX $40/mo
Facial Injections:$2500-$10,000
Rogaine: $35/mo
Propecia: $80/mo
Hair Transplant:$12,000-$30,000
Oxandrin: $1100/mo
Nandrolone: $40/mo
Testosterone gel:$700/mo
Gym: $40/mo
Serostim: $3000/mo
Supplements: Omega 3, whey, multi, Carnitine, Coenzyme Q10, Vit D: $ 90/mo
Trainer: $240/mo
Liposuction: $20,000
Creams: $30+/mo
Haircut: $40+/mo)Veneers: $8000-16000
Breast Implants:$5000
Supplements- Are They Worth It?Micronutrient Micronutrient SSupplementation upplementation SStudies tudies HHave ave SShown hown a a Wide Wide RRange ange of of BenefitsBenefits
n Reduced morbidity and hospitalizations in adults ( B, C, E ( B, C, E -- FawziFawzi et al, et al, 2004; Se 2004; Se -- BurbanoBurbano et al, 2003)et al, 2003)
nn Increased Increased survivalsurvival in adults in adults ((FawziFawzi et al, 2004; et al, 2004; JiamtonJiamton et al, 2003) et al, 2003)
n Improved immune recovery in adults on HAART (Kaiser et al, 2006; (Kaiser et al, 2006; OdunukweOdunukwe, 2006), 2006)
n Increased weight gain in HIV+ pregnant women ((VillamorVillamor et al, 2002)et al, 2002)
n Reduced morbidity and improved growth in HIV+ children (Vitamin (Vitamin A A –– CoutsoudisCoutsoudis et al, 1995; BCE et al, 1995; BCE –– VillamorVillamor et al, 2002; 2005; Zinc et al, 2002; 2005; Zinc –– BobatBobat et al, 2005)et al, 2005)
n Improved birth outcomes and infant immune status ((FawziFawzi et al, et al, 1998; 2003; 1998; 2003; FriisFriis et al, 2004)et al, 2004)
n Reduced MTCT in nutritionally and immunologically vulnerable((FawziFawzi et al, 2002)et al, 2002)
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SupplementsSupplements-- What Works?What Works?nn Niacin Niacin 10001000--3000 mg/day 3000 mg/day
–– Increases good cholesterol (HDL). Caution with Increases good cholesterol (HDL). Caution with “flushing”. Take a baby aspirin 20 min before taking “flushing”. Take a baby aspirin 20 min before taking niacinniacin
nn SeleniumSelenium–– Glutathione production (antiGlutathione production (anti--oxidant. A study showed oxidant. A study showed
people who took 200 mcg/day had better CD4 cellspeople who took 200 mcg/day had better CD4 cells
nn Omega 3 oils (fish oils) Omega 3 oils (fish oils) 30003000-- 6000 mg/day6000 mg/day–– Decreases cholesterol/triglycerides, antiDecreases cholesterol/triglycerides, anti--inflammatory, inflammatory,
mood stabilizer?mood stabilizer?
nn LL--CarnitineCarnitine 10001000--3000 mg/day3000 mg/day–– Helps use fat for energy, cell protection, lowers lipids, Helps use fat for energy, cell protection, lowers lipids,
antianti--catabolic, heart muscle protection, Ncatabolic, heart muscle protection, N--Acetyl Acetyl CarnitineCarnitinemay restore nerve damage in neuropathymay restore nerve damage in neuropathy
nn B Vitamins B Vitamins (100 mg each/day)(100 mg each/day)-- whole body whole body processes, possible prevention of mitochondrial toxicityprocesses, possible prevention of mitochondrial toxicity
Supplements and HIVSupplements and HIV--Any data?Any data?
nn Glutamine Glutamine PowderPowder-- 1010--30 grams/day30 grams/day
–– Gut and immune system protection, antiGut and immune system protection, anti--cataboliccatabolic
nn Whey ProteinWhey Protein 2020--100 grams/day100 grams/day
–– Popular with bodybuilders. HIV study found Popular with bodybuilders. HIV study found compensatory response. People ate less food and compensatory response. People ate less food and no increased LBM was foundno increased LBM was found
nn CreatineCreatine 55--15 grams/day15 grams/day
–– Muscle Muscle voluminizervoluminizer, strength enhancer. Caution , strength enhancer. Caution with diarrhea and kidney overload. Small HIV with diarrhea and kidney overload. Small HIV study found no benefitstudy found no benefit
n Calcium Carbonate- 400-1000 mg/day + Vitamin D-1000- 2000+ IU/day
– Bone protection, diarrhea control
Get to know the HIV Buyers Clubs
n The New York Buyers Club
NewYorkBuyersClub.org
1-888-650-4983
“The Supplement” Newsletter
n Houston Buyers Club –HoustonBuyersClub.com 713-520-5288
n AIDS Treatment Initiatives (Atlanta)
404-659-2437
Protecting Your Heart
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Inconsistent Results: From major studies on CVD risk in HIV-infected and HAART-treated patients
Study N Study Event ARV Effect Traditional risk factors
VA1 36,766 R 1,207 CHD
HAART or PI No Not evaluated
HOPS8 1807 P 84 CV events
Specific ARVs No Age >40 y, diabetes, HTN
SMART9 5472 p 63 CHD
Intermittent HAART
No – stopping therapy led to complication
Age
Kaiser3 4408 R 86 MI PIs Risk of HIV+ vs. HIV-No risk on PI
Not evaluated
Medi-Cal4 28,513 R NA ART Risk with ART in 18–33 year olds
Not evaluated
DAD2 23,490 P 345 MI cART and PI Yes Smoking, age, gender, HTN, DM
French5 34,976 R 49 MI PI Yes Age
Johns Hopkins6
2671 Case control
43 CHD
HIV+ vs. HIV- Yes Age, HTN, DM
Frankfurt7 4993 R 29 MI HAART Yes Age >40
1. Bozzette SA, New Eng J Med. 2003;348:702–102. Friis-Møller N, 13th CROI, Denver 2006, #1443. Klein D,13th CROI, Denver 2006, #737
7. Rickerts V, Eur J Med Res. 2000;5:329–338. Lichtenstein K, 13th CROI, Denver 2006, #7359. El-Sadr W, et al. 13th CROI, Denver 2006, #106LB
4. Currier JS, JAIDS. 2003;33:506–125. Mary-Krause M, AIDS. 2003;21:2479–866. Moore RD, 10th CROI, Boston 2003, #132
Traditional factors are the biggest contributors to coronary heart disease (CHD) in HIV
HIV infection
HAART
?
CHD Risk --
Diabetes*Metabolic syndrome
Lipids*
Family history
Abdominal obesity*
Hyper-tension*
Cigarette smoking
Hyper-glycemiaInsulin
resistance*
Inactivity, diet
Age
Gender
Orange = Modifiable
Green = Non-modifiable
Multivariable Poisson model adjusted for age, sex, BMI, HIV risk, cohort, calendar year, race, family history of CVD, smoking, previous CVD event, TC, HDL, hypertension, diabetes.
Relative Rate of MI (95% CI)
WorseBetter
0.1 0.5 1 5 10
RR: 1.86 (1.31-2.65)Diabetes (yes vs no)
RR: 1.30 (0.99-1.72)Hypertension (yes vs no)
Family history
Previous CVD
Male sex
Age per 5 yrs older
Smoking
RR: 1.40 (0.96-2.05)
RR: 2.92 (2.04-4.18)
RR: 2.13 (1.29-3.52)
RR: 4.64 (3.22-6.69)
RR: 1.32 (1.23-1.41)
Friis-Møller N et al. N Engl J Med. 2007;356:1723-1735.
D:A:D: Traditional Risk Factors for CHD in anHIV-infected Population
Total cholesterol Triglycerides
LDL cholesterol
HDLcholesterol
Lipid profile before HIV infectionLipid profile before HIV infection Lipid profile due to HIV infectionLipid profile due to HIV infection
Total cholesterol Triglycerides
LDL cholesterol
HDLcholesterol
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Lipid profile due HAARTLipid profile due HAART
Total cholesterol Triglycerides
LDL cholesterol
HDLcholesterol
*Death from CVD, silent or clinical MI, stroke, CAD requiring invasive procedure.
Number at risk
DC 2,752 1,306 713 379 10
VS 2,720 1,292 696 377 10
% w
ith a
majo
r C
VD
eve
nt*
Years from Randomization
VS**
DC**Relative hazard:1.57 (1.00-2.46)p = 0.05
0
1
2
3
4
5
0 0.5 1 1.5 2 2.5 3 3.5 4
Phillips A et al. (SMART Study Group). 14th CROI 2007; Los Angeles, CA. Abstract 41.
DC = drug conservation armVS = viral suppression arm
Risk of major CVD events* by study arm in SMART
ART and Lipids in Naïve Patients (Adapted From Eckhardt and Glesby Curr Opin HIV/AIDS 2008)
Drug NRTI T chol LDL HDL TG TC:HDL
ATV/r TDF/FTC
LPV ABC/3TC
LPV TDF/FTC
FAPV/r ABC/3TC
FAPV/r TDF/FTC NA
DRV/r TDF/FTC
EFV ZDV/3TC NA
EFV TDF/FTC NA
MVC ZDV/3TC NA
RTG TDF/FTC No chg
Study # Events
Type of Event
PI effect Type of Study
Coplan,2003 19 MI No RCT
Phillips, 2008 31 CVD Y RCT
Holmberg, 2002 21 CVD Y P Cohort
Iloeje, 2005 127 CVD Y P Cohort
DAD I, 2007 345 MI Y P Cohort
Mary Krause, 2003 66 MI Y Retro
Rickerts, 2000 29 MI ART effect Retro
Klein, 2007 162 CAD adm Y Adm Data
Bozette, 2003 1207 CAD adm No Adm Data
Currier, 2003 1360 CAD adm ART Adm
Adapted from Currier J, Lundgren JD et al. Circulation, July 2008
Lipid profile due HAARTLipid profile due HAART
Insulin resistanceType 2 diabetes
DyslipidemiaHigh FFA
Small dense LDLLow HDLHigh TG
Central obesity
HAARTCVD
Inflammation ?HIV
Age, genetics, diet, hypertension, sedentery life style, renal disease…
Smoking
GlucoseCoagulationBlood pressure Lipids
Confirm DMand treat
Drug treatment if:Established CVD or
Age ≥ 50 and 10 yearCVD risk ≥20%
Drug treatment if:SBP≥140 or
DBP≥90 mmHg(especially if 10 year
CVD risk ≥20%)
Drug treatment if:Established CVD orT2D or 10 year CVD
risk ≥20%
Assess CVD risk in the next 10 years
Advise on diet and lifestyle in all patientsConsider ART modification, if 10 year CVD risk ≥20%
Identify key modifiable risk factors
EACS Guideline for nonEACS Guideline for non--infectious Coinfectious Co--Morbidities in HIVMorbidities in HIV
EACS Guideline for non-infectious Co-Morbidities in HIV, 2009 www.eacs.com
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Smoking
GlucoseCoagulationBlood pressure Lipids
Assess CVD risk in the next 10 years
Advise on diet and lifestyle in all patientsConsider ART modification, if 10 year CVD risk ≥20%
Identify key modifiable risk factors
EACS Guideline for non-infectious Co-Morbidities in HIV, 2009 www.eacs.com
Target
If T2D or prior CVD or CKD +
proteinuria
Others
SBP<130 <140
DBP<80 <90
Target
N/A
Consider to treat with acetylsalicylic acid
75-150mg
Target
HbA1c <6.5-7%
TargetBest Standard
TC ≤4(155)
≤5(190)
LDL ≤2(80)
≤3(115)
EACS Guideline for nonEACS Guideline for non--infectious Coinfectious Co--Morbidities in HIVMorbidities in HIV The Effect of Cholesterol Medications on LDL, HDL, and Triglycerides
Additional Therapy When LDL Goals Are Not Reached With Statins
Drug Effects in the General Population
Comments
Niacin ↓ LDL 5% to 25%↑ HDL 15% to 35%↓TG 20% to 50%
§ Start with 500 mg; increase progressively to 2000 mg§ Caution in patients with diabetes or insulin resistance,
gout, or abnormal LFTs§ Use aspirin to prevent flushing
Fibrates ↓ LDL 5% to 20%↑ HDL 10% to 35%↓ TG 20% to 50%
§ Most frequently used to treat hypertriglyceridemia§ Caution in elderly and patients with abnormal LFTs§ Monitor CPK
Ezetimibe(Zetia)
↓ LDL 25%↑ HDL 3%↓ TG 14%
§ Generally added to a statin§ In HIV-infected patients, do not use fixed combination
with simvastatin(Zocor)§ Monitor Liver function tests
Fish oil ↓ LDL 10% to 20%↑ HDL 4% to 5%↓ TG 20% to 50%
§ Not all formulations equivalent§ GI intolerance most frequent adverse effect§ Usually used in combination with a fibrate or a statin
Lipid lowering agents and PIs:Drug interactions
* AUC ↑↑↑ with darunavir
FibratesFluvastatin
(Lescol)Pravastatin
(Pravachol*)EzetimibeFish oil
Use cautiously
Statin + FibrateAtorvastatin
(Lipitor)Rosuvastatin
(Crestor)Niacin
Lovastatin(Mevacor)
Simvastatin ( Zocor)
Contraindicated
Low interactionpotential
1. Fichtenbaum CJ, et al. AIDS. 2002; 16:569–77; 2. Hsu A, et al. AAC. 2001; 45:3445–50; 3. Gerber J, et al. 2nd IAS
2003, #870; 4. Carr RA, et al. 40th ICAAC, Toronto, 2000. #1644; 5. Telzir Package Insert 2003; 6. Gerber JG, et al. 11th CROI. 2004. # 603; 7. Reyataz Package Insert 2005; 8. Aptivus Product Label 2005
How To Minimize Heart Disease
nn Do not smoke!Do not smoke!nn Exercise and low animal fat/sugar dietExercise and low animal fat/sugar dietn Lose weight if you are overweightif you are overweightnn Manage stress. RelaxManage stress. Relax!!n Manage blood pressuren Decrease triglycerides es with Omega with Omega 3 fatty acids 3 fatty acids
(cold water fish oils)(cold water fish oils)nn Improve fat utilization Improve fat utilization with Lwith L--CarnitineCarnitine
(prescription (prescription CarnitorCarnitor) 2) 2--4 grams a day4 grams a daynn Improve HDL Improve HDL with Niacin with Niacin 300300--500 mg 3 x day. 500 mg 3 x day. Start Start
with lower dose to minimize “flushing” and take an aspirin with lower dose to minimize “flushing” and take an aspirin 20 min before (20 min before (NiaspanNiaspan is the prescription grade)is the prescription grade)
nn If everything else fails, use If everything else fails, use prescriptionprescription lipid lipid lowering agents lowering agents ((statinsstatins, , fibratesfibrates, etc, etc))
nn A A baby aspirin baby aspirin a a day day (81 mg(81 mg))nn HIV med switchHIV med switch: : KaletraKaletra to to ReyatazReyataz, PI to , PI to
Isentress, Isentress, SustivaSustiva to to ViramuneViramune
How to Prevent and Reverse Fatigue
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FatigueFatiguenn Possible causesPossible causes: infections, low testosterone and/or : infections, low testosterone and/or
DHEA, anemia, medications, vitamin deficiencies, DHEA, anemia, medications, vitamin deficiencies, depression, sleep problems, depression, sleep problems, hypoglycemiahypoglycemia, heart , heart problemsproblems, , etcetc
nn Check your Check your testosterone, DHEA & thyroid hormonestestosterone, DHEA & thyroid hormonesand them raised if they are lowand them raised if they are low
nn Drink lots of waterDrink lots of waternn Multivitamins, BMultivitamins, B--12 shots12 shotsnn AntidepressantsAntidepressantsnn ExerciseExercise, even if it is light and for short periods of , even if it is light and for short periods of
timetimenn Attention Deficit DrugsAttention Deficit Drugs ((AdderallAdderall, , StrateraStratera))nn Better sleep habitsBetter sleep habits. . Sleep Sleep apnea diagnosis. Sleep apnea diagnosis. Sleep
meds like meds like AmbienAmbien and and LucertaLucerta. Supplements: . Supplements: Melatonin and TryptophanMelatonin and Tryptophan
nn ProvigilProvigil, , NuvigilNuvigil: : medication to treat excessive sleepiness medication to treat excessive sleepiness caused by narcolepsy, obstructive sleep apnea syndrome , and caused by narcolepsy, obstructive sleep apnea syndrome , and shift work sleep disorder .shift work sleep disorder .
Protecting Your Sexual Function
Risk Factors that Affect Erections
Testosterone and AgingTestosterone and Aging
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Medications that May Affect Sexual FunctionMedications that May Affect Sexual Function
nn AntidepressantsAntidepressants: Selective serotonin reuptake inhibitors : Selective serotonin reuptake inhibitors (SSRIs), (SSRIs), tricyclictricyclic antidepressants, monoamine antidepressants, monoamine oxidaseoxidaseinhibitorsinhibitors
nn Blood pressure medications Blood pressure medications ((antihypertensivesantihypertensives): Alpha ): Alpha andregenergicandregenergic antagonists, betaantagonists, beta--blockers, diuretics, blockers, diuretics, guanethidineguanethidine, methyldopa, methyldopa
nn Narcotics and opiatesNarcotics and opiates
nn Barbiturates and benzodiazepinesBarbiturates and benzodiazepines
nn Hormone related productsHormone related products: Anabolic steroids, : Anabolic steroids, antiandrogensantiandrogens used in prostate cancer, estrogens, used in prostate cancer, estrogens, medroxyprogesteronemedroxyprogesterone, 5, 5--alphaalpha--reductase inhibitorsreductase inhibitors
nn AntiAnti--acidsacids: Histamine 2 receptor antagonists, proton pump : Histamine 2 receptor antagonists, proton pump inhibitorsinhibitors
nn Cholesterol Cholesterol ––lowering agentslowering agents: Bile acid : Bile acid sequestrantssequestrants, , fenofibratesfenofibrates, , statinsstatins
Sexual Dysfunction Oral DrugsSexual Dysfunction Oral DrugsDrugDrug Onset of Onset of
ActionActionDuration of Duration of
ActivityActivity
ViagraViagra 60 minutes60 minutes 44--5 hours5 hours
LevitraLevitra 30 minutes30 minutes 44--5 hours5 hours
15 minutes15 minutes 36 hours36 hoursCialisCialis
Side Effects: Heartburn, GI upset, head aches,Side Effects: Heartburn, GI upset, head aches,nasal congestion, flushing, “blue vision” (Viagra only)nasal congestion, flushing, “blue vision” (Viagra only)
Trimix (Papavarine+ Phentolamine + alprostadil)
Available by prescription from compounding pharmacies
Food as MedicineFood as Medicine
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What Your Plate Should Look Like….
Is Pre-Diabetes Common in HIV?
FBG: Fasting Blood Glucose
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High Carbohydrate Intake High Carbohydrate Intake May Increase TriglyceridesMay Increase Triglycerides
“High carbohydrate load may worsen“High carbohydrate load may worsen
triglycerides in this (HIV+) population alreadytriglycerides in this (HIV+) population already
with a tendency to elevated lipids”with a tendency to elevated lipids”
K. Mulligan. 4th International Conference on Nutrition and HIV InfectionK. Mulligan. 4th International Conference on Nutrition and HIV Infection
and the 2nd European Workshop on Lipodystrophyand the 2nd European Workshop on Lipodystrophy
April 19 April 19 -- 21, 2001, Cannes, France 21, 2001, Cannes, France
Low- Fat vs Mediterranean vs Low-Carbohydrate
Diets- Effect on Weight Loss
DIET Study (DIET Study (DDietary ietary IIntervention:ntervention:EEffects ffects on on TTryglicerides in HIV Lipodystrophy)ryglicerides in HIV Lipodystrophy)
nn Using food records that began from 6 to 24 months before Using food records that began from 6 to 24 months before development of fat deposition the following factors were development of fat deposition the following factors were identified.identified.
When compared to people with HIV who developed fat When compared to people with HIV who developed fat deposition, patientsdeposition, patients without fat depositionwithout fat deposition had:had:
-- greater overall energy intakes from their diet (p = 0.03)greater overall energy intakes from their diet (p = 0.03)-- greater intakes of total protein (p = 0.01)greater intakes of total protein (p = 0.01)-- more total dietary fiber (p = 0.01)more total dietary fiber (p = 0.01)-- more soluble dietary fiber (p = 0.01)more soluble dietary fiber (p = 0.01)-- insoluble dietary fiber (p = 0.03)insoluble dietary fiber (p = 0.03)-- pectin (P = 0.02)pectin (P = 0.02)
Those without fat deposition also were currently doing Those without fat deposition also were currently doing moremoreresistance training exercise and were less likely to be smokingresistance training exercise and were less likely to be smoking (only borderline statistical significance (p = 0.05))(only borderline statistical significance (p = 0.05))
Hendricks at al, Am J Clin Nutr, 2003 Oct;78(4):790-5
Nutritional Considerations• Reduce saturated (animal) fats, fried foods
and hydrogenated oils
• Eat omega-3 fish oil-rich foods- salmon, tuna, sardines or flax seed oil (alternative)
• Use monounsaturated fats: olive oil
• Minimize sugar, fructose (sweets, sodas, foods with high fructose corn syrup )
• Eat adequate amounts (0.7-1 gm/lb/day) of protein (fish, eggs, cottage cheese, lean meats, chicken, whey, nuts, etc)
More Nutritional Considerations
• Do not skip breakfast (keep an eye on sugar and refined flower products!)
• Try to eat several smaller meals or snacks instead of 2-3 large ones
• Eat more almonds, walnuts, pecans and pistachios (good cholesterol lowering fats)
• Eat fruits and vegetables of all colors
( varied antioxidant profile)
• Eat a high protein, complex carbohydrate-rich meal after work outs
• Minimize caffeine (it reduces appetite)
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Grocery Shopping ListGrocery Shopping List
nn Almonds and other nutsAlmonds and other nuts
nn Beans and other legumesBeans and other legumes
nn Spinach and other green leafy vegetablesSpinach and other green leafy vegetables
nn Low fat dairy, yogurt (lactose tolerant)Low fat dairy, yogurt (lactose tolerant)
nn Whey proteinWhey protein
nn OatmealOatmeal
nn EggsEggs
nn Lean meatsLean meats
nn Whole grain breads and pastaWhole grain breads and pasta
nn Peanut, almond , cashew buttersPeanut, almond , cashew butters
nn Olive oil , salsa and avocadosOlive oil , salsa and avocados
nn Raspberries and all berries. Fruits of all colors(avoid fruit juices)Raspberries and all berries. Fruits of all colors(avoid fruit juices)
nn One or two glasses of red wine per day (optional)One or two glasses of red wine per day (optional)
nn Flaxseed , pumpkin and sunflower seedsFlaxseed , pumpkin and sunflower seeds
nn Sweet potatoesSweet potatoes
nn Green teaGreen tea
Food affects on protease inhibitor blood levels -Area Under the Curve (AUCs):
-77%
-6X
-3X
-55%
IDVIDV LPV/rLPV/r ETVETV SQVSQV
If taken w/ food . .If taken w/ food . . If taken on empty stomach . . .If taken on empty stomach . . .
-70%
ATVATVfAPV
-10%
APV
-14%
Exercise, the Best Therapy for Most Health Problems
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Exercise: The Best MedicineExercise: The Best MedicineBenefits:
↓↓ total and abdominal fattotal and abdominal fat
improves insulin sensitivityimproves insulin sensitivityimproves glucose toleranceimproves glucose toleranceincreases HDL cholesterolincreases HDL cholesterol
↓↓ triglycerides and LDL triglycerides and LDL increases muscle massincreases muscle massimproves enduranceimproves enduranceimproves strengthimproves strengthimproves bone densityimproves bone densityimproves moodimproves mood
Lipodystrophy Body Changes: Lipodystrophy Body Changes: Effect of Effect of ExerciseExercise
nn 10 men with truncal obesity 10 men with truncal obesity
nn Intensive 16Intensive 16--week programweek program
nn Significant decrease in total body fat (3.3 Significant decrease in total body fat (3.3 Lb, Lb, PP < 0.01)< 0.01)
nn Greatest Greatest decreasedecrease was in trunk fat (2.43 Lb, was in trunk fat (2.43 Lb, PP < 0.03)< 0.03)
nn Significant decrease in triglycerides Significant decrease in triglycerides observedobserved
Roubenoff R. et al. AIDS.1999;13:1373-5.
Strength Training Improves Insulin Sensitivity and Strength Training Improves Insulin Sensitivity and Reduces Body Fat in HIV + Patients with Reduces Body Fat in HIV + Patients with
LipodystrophyLipodystrophy
• • Only strength training increased total lean body mass (by 2.1 kg), and decreased total fat (3.3 kg), trunk fat (by 2.5 kg), and limb fat (by 0.75 kg).
• Strength training decreased total fat and limb fat mass to a significantly larger extent than endurance training (P < 0.05).
• Endurance training was associated with reduced levels of total cholesterol, low-density lipoprotein (LDL or "bad") cholesterol, free fatty acids (FFAs), high-sensitivity C-reactive protein, interleukin 6 (IL-6), IL-18, and tumor necrosis factor alpha (TNF-alpha), and increased high-density lipoprotein (HDL or "good") cholesterol (P < 0.05 for all measurements).
• Strength training was associated with decreased triglycerides, FFAs, and IL-18,
and increased HDL cholesterol (P < 0.05 for all measurements).
B Lindegaard, T Hansen, T Hvid, and others. The effect of strength and endurance training on insulin sensitivity and fat distribution in HIV-infected patients with lipodystrophy. Journal of Clinical Endocrinology and Metabolism 93(10): 3860-3869. October 2008
Exercise ± Oxandrolone in Patients on HAART
Aerobic (Cardiovascular) Aerobic (Cardiovascular) ExerciseExercise
nn Start with a brisk walk every day if tiredStart with a brisk walk every day if tired
nn Concentrate in Concentrate in low impact or no impactlow impact or no impactexercises (e.g. Elliptical Trainers)exercises (e.g. Elliptical Trainers)
nn Do what you enjoyDo what you enjoy (bicycling, roller (bicycling, roller skating, etc)skating, etc)
nn Good for burning fat, triglycerides, blood Good for burning fat, triglycerides, blood sugar, but it may decrease muscle masssugar, but it may decrease muscle mass
nn 20 20 -- 30 minutes 330 minutes 3--4 times a week is 4 times a week is enough for many peopleenough for many people
nn Cardiovascular exercise may increase fat Cardiovascular exercise may increase fat loss under the skin loss under the skin
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Progressive Resistance Progressive Resistance Exercise (PRE)Exercise (PRE)
nn Warm up and stretchWarm up and stretch before a sessionbefore a session
nn Start with compounded exercisesStart with compounded exercises
nn Lift maximum weight for muscular failure Lift maximum weight for muscular failure (exhaustion) at (exhaustion) at 88--12 repetitions12 repetitions
nn One body part per weekOne body part per week
nn One hour sessions 3One hour sessions 3--4 times a week4 times a week
nn One light set and two heavier sets per body partOne light set and two heavier sets per body part
nn If no access to a gym, start with crunches, push If no access to a gym, start with crunches, push ups, and squats at home. Use stairs!ups, and squats at home. Use stairs!
nn For more details, visit For more details, visit www.medibolics.comwww.medibolics.com
Best Exercise Sites with Best Exercise Sites with videos, etcvideos, etc
www.exrx.netwww.exrx.net
www.MyFit.ca
Ipod exercise routine downloads:http://www.menshealth.com/download/
Mindfulness Study in HIVMindfulness Study in HIV
nn EightEight--week mindfulnessweek mindfulness--based stressbased stress--reduction (MBSR) reduction (MBSR) meditation programmeditation program and compared it to a oneand compared it to a one--day MBSR day MBSR control seminar, using a stressed and ethnically diverse control seminar, using a stressed and ethnically diverse sample of 48 HIVsample of 48 HIV--positive adults in LApositive adults in LA
nn Participants in the eightParticipants in the eight--week group showed week group showed no loss of no loss of CD4 T cellsCD4 T cells, indicating that mindfulness meditation training , indicating that mindfulness meditation training can buffer declines. In contrast, the control group showed can buffer declines. In contrast, the control group showed significant declines in CD4 T cellssignificant declines in CD4 T cells from prefrom pre--study to poststudy to post--study. study.
nn The researchers were also encouraged because the overall The researchers were also encouraged because the overall CD4 T cell effects remained even after controlling for a CD4 T cell effects remained even after controlling for a number of factors that could have skewed the study number of factors that could have skewed the study
results.results.
Creswell, David. University of California, Los Angeles (2008, July 27). Mindfulness Meditation Creswell, David. University of California, Los Angeles (2008, July 27). Mindfulness Meditation Slows Progression Of HIV, Study Suggests.Slows Progression Of HIV, Study Suggests. ScienceDailyScienceDaily..
SummarySummarynn Find out your Find out your free testosterone and thyroid free testosterone and thyroid function if you function if you
have fatigue, sexual dysfunction, etc. Supplement if have fatigue, sexual dysfunction, etc. Supplement if needed. Ask for a higher testosterone gel dose if free needed. Ask for a higher testosterone gel dose if free testosterone is not over 50 pg/dltestosterone is not over 50 pg/dl
nn Have your doctor check your blood levels of Have your doctor check your blood levels of 25(OH)D and supplement with Vitamin D if needed.
n Ask your doctor to prescribe a DEXA bone scan to ensure that you do not have bone loss
n Go to facialwasting.org for patient assistance program info, doctor’s list and general info on facial and buttock reconstruction
n Avoid sweets, hydrogenated oils, high fructose corn syrup, animal fats and consume more fruits, vegetables, fish and nuts.
n Keep your mind challenged to slow down cognitive decline. Take classes, learn a language, play games, etc
SummarySummarynn Have a high resolution Have a high resolution anoscopyanoscopy with a trained colon/rectal with a trained colon/rectal
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nn You do not have to accept You do not have to accept sexual sexual dysfunction as a reality dysfunction as a reality of aging. There are several treatment options!of aging. There are several treatment options!
nn Do not waste money and take liver or interaction risks with Do not waste money and take liver or interaction risks with unproven unproven supplementssupplements. Stick to niacin, omega 3’s, . Stick to niacin, omega 3’s, mutivitaminmutivitamin with selenium, vitamin D, acidophilus, with selenium, vitamin D, acidophilus, carnitinecarnitine, and , and SAMeSAMe. Support your buyers clubs. Support your buyers clubs
nn Combat potential frailty while aging with HIV with Combat potential frailty while aging with HIV with resistance and cardiovascular resistance and cardiovascular exerciseexercise 3 to 4 times a week 3 to 4 times a week for an hourfor an hour
nn If you are losing weight involuntarily, talk to your doctor If you are losing weight involuntarily, talk to your doctor about about nandrolonenandrolone or or OxandrinOxandrin to increase lean massto increase lean mass
nn Try mindfulness meditation, hobbies, etc to quiet your Try mindfulness meditation, hobbies, etc to quiet your mind and mind and decrease stress decrease stress levelslevels
For More InformationFor More Informationnn More details in “Built To Survive” and More details in “Built To Survive” and
”Testosterone”Testosterone-- A Man’s Guide” and upcoming A Man’s Guide” and upcoming “Beyond Survival”“Beyond Survival”
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nn Email:Email:
Nelson Nelson VergelVergel –– [email protected]@gmail.com
nn Websites:Websites:
www.powerusa.comwww.powerusa.com
www.facialwasting.orgwww.facialwasting.org
www.TheBody.comwww.TheBody.com
nn Join my Internet discussion group by sending a blank Join my Internet discussion group by sending a blank email to email to [email protected]@yahoogroups.com
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