Researchers have suggested that HIV infection may cause an accelerated transformation of muscle mass to fat by interfering with metabolism and hormonal regulation. Muscle mass is important to immune function and serves as a storehouse for protein, thus protecting against starvation. It is also a reservoir of glutamine, an amino acid that may improve gastro-intestinal function. Thus, if muscle mass is converted to fat, a person with HIV infection is put at a considerable risk. Exercise is a natural method to reverse the conversion of muscle to fat tissue; it may also be helpful to provide certain hormones that decline with HIV infection (like growth hormone, testosterone, and adrenal steroid hormones).

IEP (Portland) is conducting a study to investigate the connection between body fat, exercise, and health, with an emphasis on gastro-intestinal function. The preliminary findings from this study, based on analysis of about one third of the gathered data, show that regular and intensive exercise correlates with lower levels of body fat and fewer gastro-intestinal problems. People with lower body fat levels may also generally enjoy better digestive health, although the findings on this are not yet conclusive. The study has at this time found no evidence that HIV-infection causes a substantial increase in body fat as compared to the general population. From these results, it is possible to suggest some guidelines: Those with high body fat levels (around and above 20% for men, 27% for women), should increase and intensify their exercise to reduce excess fat and help increase muscle mass. It is important that any exercise increases be undertaken cautiously to avoid injury, since an injury will end up producing lower levels of exercise. Generally, dietary steps should be taken in order to control body fat levels and maintain muscle mass.

Barry Sears, Ph.D., who works primarily with athletes, suggests that a proper balance of protein, fat, and carbohydrates (30% protein, 30% fat, and 40% carbohydrates) can normalize hormone levels and improve overall health. This approach pays closer attention to getting adequate protein, and worries less about fat. High protein levels can cause problems in persons who do not exercise, but such potential problems are eliminated by exercise. This leaves the question of how much fat to include in a diet. Persons with AIDS tend to have high triglycerides (one type of fat) and low cholesterol (another type of fat). Triglycerides arise mainly from elevated levels of TNF (tumor necrosis factor), and will decline if TNF declines (which can easily be done by taking a short course of drug therapy using Trental, Thaliomide, or Ketotifin). They are not reduced by a low fat diet. As for cholesterol, high levels are associated with poor cardiovascular health, but low levels are potentially problematic, they can lead to low levels of steroid hormones, which results in metabolic disorders, and abnormal cell metabolism, which may initiate cancer. AIDS patients therefore may want to increase cholesterol levels; this involves improving digestive health and possibly including cholesterol-containing foods such as eggs and certain shellfish in their diet.

IEP (Portland) is initiating a diet and nutrition analysis program and will provide suggestions for balancing the dietary components. In addition, we are developing exercise programs to promote muscle mass development and improve gastro-intestinal health.