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(Antiretroviral Therapy) and Nutrition in HIV and AIDS
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ART and Nutrition
in HIV and AIDS

The Third Voice,
by David Patient & Neil Orr

May, 2006

    For the last few years we have been following the ART (antiretroviral) medication versus nutrition debate in South Africa.This debate is not unique in the world. What makes it unique is the scale of it, and that the government is (correctly or incorrectly) placed within the 'alternative' camp, with civil society (e.g., TAC) as the apparent protagonist of mainstream science and medicine. This has led to a highly polarised situation, with common sense nowhere in sight, and the victims being those infected.

How is it possible that, in a civilised society, people are being asked to choose between appropriate medication and food to keep their body healthy? Do we ask the same of those with diabetes or heart disease? Since when has there been any question that maintaining body strength through exercise and nutrition is in conflict with proper medical treatment? It defies logic, yet that is what the public is being led to believe.

Initially, the ART lobby groups stated that their opposition to promoting nutritional measures was simply to ensure that ART access was placed on the forefront of government responsibilities to those infected. This is understandable and laudable. Indeed, their efforts were essential in making ART more widely available to those infected. Many lives have been saved as a direct result of their efforts. And yes, more work is required to make ART more widely available.

In response, some of the 'nutrition-only' protagonists escalated their efforts and claims, telling people that ART is deadly, and that AIDS can be cured with various plants, vitamins, and minerals.

In all this heated debate, a simple fact has been overlooked: Adequate and appropriate nutrition is - and always been - a critical factor in defending against illness, and sustaining optimum health. Common sense - the missing factor in this debate - is that medication and nutrition are both important to ensuring health and warding off disease: The one fights germs, and the other strengthens the body. Where's the conflict?

The conflict lies in the fact that most people - not only those living with HIV - are largely ignorant of the basic facts about both ART and nutrition, and also when and where those options are appropriate. To make things worse, the media is not doing a very good job of explaining how things work in HIV.

You may ask what right we have in commenting upon these issues. Yes, one author (David Patient) is living with HIV, since 1983. However, infection with the virus does not automatically imbue you with insight, wisdom or information regarding the disease, medicine, or how your body works. Instead, it is useful to note that David has been involved in HIV and AIDS activism long before ART as we know it came onto the scene.

Like many others, whenever there was a claim of some 'miracle' treatment or cure (e.g., Compound Q from Chinese cucumber, and AL721 from egg yolk), he was one of the first to give it a go. When AZT - the first ART available - came onto the scene, he was part of the first human clinical trials, back in 1986 at Duke University.

The fact that none of the 'miracle cures' cured anything, nor the fact that the doses of AZT back in 1986 were so toxic that most subjects died, is not as important as recognising that - like most people living with HIV - he wanted to live, and wanted options to do this. When second-generation ART's became available in the early 1990's (3TC, and D4T), both authors helped get these medications to South African AIDS patients.

We have also been part of the nutrition and HIV debate since it's early days and in some instances, we instigated it. We spent several years poring over research documents on nutrition and viral infections, distilling these into guidelines that have become the basis for many nutritional interventions for those living with HIV. We even published a book on it called Positive Health that currently has a circulation of over 14 million copies.

When originally published in 1999, ART was simply not available to the general public, and it was felt that people living with HIV needed to know what else they could do to sustain their health until medication was available. As access to ART improved, information on this treatment was included in the book. The point is that we have never viewed either ART or nutrition as stand-alone options. Indeed, the one supports the other.

Rarely has there been a period of time when we have not been approached to promote some or other product, herbal or otherwise, which the developers claim to 'cure' HIV and or AIDS. We have investigated many of these, sometimes through personal trials. And no, we have not found the cure in any of these 'miracle cures'.

Instead, we have gained a great deal of insight into how traditional medicine and western medicine view treatments and cures quite differently. For example, traditional medicine views a cure as the alleviation of symptoms, whereas western medicine views a cure as the removal of the causative agent, such as HIV. Hence, there is a perennial misunderstanding in this regard.

So, at the risk of being presumptuous, we believe we have the experience and knowledge to make certain statements regarding the nutrition-ART debate, based upon current facts and research:

1. There is no cure for HIV from the medical, traditional healing, or 'alternative' fraternities. Instead, there are proven methods for keeping HIV under control (e.g., ART), and for strengthening the immune system (e.g., sound nutrition and other practical measures).

2. ART is effective in extending life in those living with AIDS, on average extending productive health by 4 or more years. Yes, there are those who respond badly to the medications. It is also true that long-term use often leads to side effects such as liver problems. Mixed into the equation is that early ART did indeed have severe side effects due to high dose levels. These dose levels have now been reduced to less toxic levels. All these disadvantages are outweighed by the clearly demonstrated benefits of the medication. Like any chronic medication (e.g., blood pressure pills), it requires close monitoring to detect and control the side effects.

3. Nutrition likewise extends life in those living with HIV and AIDS, but through different mechanisms to ART medication. Where ART focuses upon destroying the virus or interfering with its' ability to reproduce, nutrition focuses upon providing the body with what it needs to create new immune cells, and thus do its' part in fighting infections. These two methods are complementary, not conflicting.

4. ART is only considered appropriate when a person living with HIV reaches a CD4 (Helper T-cell) count of 200, or when an AIDS illness emerges. Therefore, simply being infected with HIV does not qualify you to receive ART. In contrast, nutrition and other practical measures such as exercise provides tangible and effective measures for people living with HIV to get involved in their health, long before AIDS emerges, and thus before ART treatment is called for. The focus of nutrition is to improve immune function, and thus prolong the period of infection before AIDS develops. It does not prevent this from occurring - it simply delays it.

5. Without awareness of nutritional interventions (and structures such as support groups), there is little motivation to get tested early, a key to effective health management. Without the promotion of empowering options such as nutrition, promoting early testing is extremely difficult. When absent, people tend to wait until they become ill before they seek assistance.

6. Specific ART medications do indeed conflict with specific foods and herbs. Examples are garlic and Ritonavir or Saquinovir, and African Potato or Sutherlandia and most ART medications. These herbs interfere with enzymes in the stomachs that absorb the medications. This conflict is resolved by waiting for several hours after taking the medications, before consuming the herbs.

7. According to published clinical trials, African Potato does indeed improve immune function. However, it does not boost the immune system, as the immune system is not a simple unified entity. Instead, it strengthens only one part of the immune system (cellular immunity). It is this part of the immune system that deals with viruses. Heat (e.g., boiling) destroys the active ingredient of African Potato, making it useless. To obtain benefit from the plant, you need to know how it was prepared.

8. Garlic has no direct effect on viruses, including HIV. Instead, it is a sulphur-based natural antibiotic, about 1/10th the strength of penicillin. Regular garlic consumption reduces bacterial, yeast and parasitic infections. This in turn allows the immune system to put more resources into fighting viral infections. Deodorised garlic is useless if the sulphur-based ingredient is removed.

9. Beetroot is high in iron. Like garlic, beetroot does absolutely nothing to viruses. Instead, the iron improves blood oxygenation, energy levels, and supports various important body functions. Dark green vegetables and liver do the same thing. Malnourished people are often anaemic, which is a condition caused mainly by low iron levels. Pregnancy can also induce anaemia.

10. Malnourished people respond poorly to medication (including ART), and have a lower resistance to infections in general. Nutritional interventions (e.g., vitamin A supplements) have little beneficial effect when applied to groups of people (including those infected with HIV) who already have an adequate and varied diet. However, when applied to groups with a restricted diet - either in quantity or variety - specific nutritional supplements have a dramatic effect on health, including response to ART. Therefore, when evaluating nutritional studies, it is important to consider the economic background of the study group. Failure to do so leads to a perception of 'sometimes it helps, and sometimes it doesn't'.

11. Given the economic and other conditions that we live in, nutritional interventions should focus upon ensuring either an adequately varied diet, or supplementation of existing diets to ensure basic nutritional needs are fulfilled. It should be clearly understood that such nutritional interventions have nothing to do with 'curing' disease. It is simply about ensuring normal immune function. Furthermore, legislation concerning mandatory fortification of popular foods types such as maize meal needs to recognise that heat destroys vitamins (but not minerals) and that certain forms (typically the cheaper forms) of vitamins and minerals are not well absorbed.

12. The most clearly scientifically proven nutritional substance to make a statistically significant difference in how long and well a person lives with HIV is selenium. This effect occurs regardless of other dietary factors, and is seen even in those who have an otherwise good diet. This effect has been demonstrated in several controlled studies. Selenium cannot reliably be obtained from most foods, as levels of selenium in food such as vegetables depend entirely upon the soil they were grown in. Commercial agricultural methods reduce selenium levels in food because of alterations of the acid/alkaline levels of the soil. The exception is the aloe, which actively extracts selenium from the soil. Sea fish also contain reliably adequate levels of selenium. You cannot overdose on selenium from food sources. However, in pill form you should not exceed 500 micrograms per day (for adults).

13. The 'remarkable' effects of various nutritional products can largely be explained in terms of simply addressing underlying malnutrition. Many people have poor diets, regardless of income or volume of food consumed. This is because of processing and preserving methods that typically destroy vitamins in food. Fresh food is far better than mass-produced food for this reason. Techniques such as trench gardens make it possible for almost anyone to grow their own vegetables, even in dry and difficult situations.

14. Variety is as important as volume. There is not one (naturally-occurring) food that can give you all that you need, nutritionally. Mono-diets (e.g., maize meal with the occasional meat) can lead to malnutrition in terms of many vitamins and minerals.

15. Maintaining normal body temperature (37 degrees Celsius) through exercise and diet (e.g., energy foods, and 'hot foods') does indeed help the body fight viruses. The cooler the body, the more active germs become. The warmer the body, the more active the immune system becomes.

16. Treatment of chronic infections such as parasitic infections (e.g., worms), TB, malaria, and sexually transmitted diseases, does increase the body's ability to fight HIV. This is simply because these infections place an additional burden upon the immune system.

The bottom-line is that nutritional interventions are extremely important in dealing effectively with HIV and AIDS: Before you need ART - during the longest period of living with HIV, the period from diagnosis to CD4 of 200 - take care of your body and give it what it needs to do its' job in keeping HIV under control for as long as possible.

There are proven natural methods that do enhance your body's ability to control and even delay the onset of many conditions. However, when your immune system becomes compromised and your CD4 count drops below 200 and your viral load increases, then ART is critical. However, even on ART, continue with good nutritional practices to maximise the benefits of ART and help your body cope with the medication.

David Patient used nutrition (that includes vitamins, minerals and good food) for most of his HIV infection. Now, 23 years into his infection, he needs ART because his immune system was starting to show some wear and tear. He takes his ART religiously each day, and he still eats well, takes his supplements, does exercise, and generally tries to take care of his body. Is this medical heresy? Is this an abandonment of nutrition?

Of course not: He didn't abandon the methods that worked for 23 years - he simply added ART to his daily regimen because that was necessary. As a result, his immune system is great (CD4 is at 900, and undetectable viral load). In addition, he hasn't had any negative side effects, and his liver enzyme tests are normal.

So what, we ask, is the debate really about? How much of it is about ego and sheer pig-headedness? Since when did medical science - or nutrition - demand faith - not a careful consideration of known facts - to determine care and treatment options? We have been around HIV and AIDS a long time, longer than most. We have never seen a verified case of someone 'cured' of HIV from any food, herb, or medication. We have, on the other hand, met many people who have lived long and healthy lives with HIV, using both medicine and sound lifestyle practices.

The objective of any treatment intervention is to promote life and health. If it does, use it. It is not a matter of faith or political conviction - it is a matter of what works, and what doesn't. Ask anyone with diabetes and other chronic illness.

When you hear someone insisting that 'this is it', be cautious: Rarely will such a person tell you of the people who did not benefit from the miracle cure . you only hear about the successes. It's your life, your body: Demand explanations and evidence. Ask questions - don't be a helpless victim in your health.


David R. Patient (M.H.;M.H.T.)
Empowerment Concepts
Ph. +27-(0)83-226-9466
Fax to email +27-(0)86-683-4585

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