Metabolic Midsection?

Have you ever looked at one of those textbooks that shows line drawings of an aging man or woman? These drawings show general body changes that are seen from birth to old age. They give you an idea of what you have to look forward to if all systems are on track. But with HIV infection (and some other chronic diseases), you might find yourself accelerating through the younger drawings toward those older ones more quickly than you prefer. While there are a lot of things you can do to stay in better shape as long as possible (like not smoking, keeping alcohol consumption below a low buzz, exercising), you can think about playing the food-groups game to keep one of the villains in check: insulin. Insulin resistance is faced by pretty much everyone at some level and at some point in life. With chronic infection, medications that can enhance or initiate the effect--as well as a lack of knowledge or initiative on your part--can accelerate and exacerbate the aging process. What magic bullet exists for this problem? As with so many things in our lives, an ounce of prevention is worth several pounds of cure. It is also worth remembering that it is difficult to reverse problems once they happen. Insulin resistance can cause a number of health problems, including increasing one's risk for cardiovascular and other diseases. One visible manifestation is the change in body fat deposits. Body fat gathering in the middle section and body fat disappearing (causing you to lose the smooth curves around your face as well as insulation around veins in your arms and legs) are both consequences and causes of this problem. So if you have those curves, think about prevention. And if you have lost some of those youthful characteristics, think of slowing down and maybe even reversing some of the effects. By looking to keep your insulin levels in control you can win twice--both in keeping your health risks in check and in continuing to look your best. The 'big guns' in controlling insulin levels are diet and exercise. Exercise can improve your body's sensitivity to insulin, helping to keep the level under control. So can diet if you plan a bit. What pushes blood sugars up is what pushes insulin up: carbohydrates. And before we go any further, you need to know that carbohydrates as a group are not such bad guys, so don't shun them altogether! But carbohydrates, like many other things in life, should be kept in balance. If carbohydrates tend to push up blood sugar and insulin, then we need to know how to counterbalance that effect. (1) Be reasonable about the carbo load you expect your body to process at any one meal. Spread your meals and carbs out across the day. If there is a time crunch or other problem that makes this difficult, talk with your dietitian to get some tips. (2) Avoid an overreacting insulin effect by balancing carbohydrates with fiber, protein, and fat, which all serve to slow carbs in their rush to enter the bloodstream. Even an ice-cold temperature in foods may help to balance how quickly carbs can enter the bloodstream. We are looking for a time-release effect. (3) Maintain a good weight. If you need to lose weight, it's a good idea to do so under the supervision of your health care professional, who can ensure that you don't unwittingly make things worse. If you need to gain weight, seek some professional advice from your dietitian on how best to do that, considering the potential for weight to lodge in all the wrong places. (4) Think about chucking other habits that increase insulin, like smoking, excessive alcohol intake, and generally being a couch potato. You probably won't know what it feels like to feel good until you adopt healthy habits. If these sound a lot like diabetic guidelines, they are! Rewire your thoughts toward a healthy lifestyle, which would benefit pretty much everyone on the planet--especially you. Fields-Gardner is the director of services for Cutting Edge, an HIV nutrition company. She is a member of the International AIDS Society and the American Dietetic Association's Dietetic Practice Group on HIV and AIDS. She has written a book on HIV medications and a guide to nutritional management of HIV for clinicians.