The term “wellness” can be summed up best by the definitions listed below.
From Dictionary.com Unabridged: 1) the quality or state of being healthy in body and mind, especially as the result of deliberate effort. 2) an approach to healthcare that emphasizes preventing illness and prolonging life, as opposed to emphasizing treating diseases.
From the American Heritage Dictionary: the condition of good physical and mental health, especially when maintained by proper diet, exercise, and habits.
There are several key points in these definitions.
1) Being in a state of wellness requires “deliberate effort.”
2) There is an emphasis not only on traditional treatment but also on prevention.
3) Good overall health requires good habits.
Most HIV providers will do a very good job of explaining the necessities of adhering to medication regimens, avoiding drugs, alcohol and smoking, and keeping routine appointments. However, other components of being well are sometimes overlooked or underemphasized. Since there is no time limit to reading this article, let’s use this opportunity to cover wellness in greater detail.
Exercise
There are precious few data to suggest an ideal exercise regimen for HIV-positive patients. In reality, there is no “one size fits all” approach to fitness, since people who are HIV-positive range in age from infants to the very old, and from the very sick to fine-tuned athletes in the peak of health. They live in every time zone in every climate. And perhaps most importantly, they range from the very well-off financially to those struggling to get by day to day.
Many people falsely believe you need a fancy gym membership or a personal trainer to get any benefit from regular exercise. In fact, just about anyone can engage in a physical activity that will convey health benefits. What is most important about exercise and fitness is not whether you are doing the “right” exercise… it is that you do something and you do it consistently.
For you, taking a brisk walk around the neighborhood several evenings a week might be right. For someone else, mountain biking through a state park or canoeing down a nearby stream might work. For others, a regular regimen at a nearby gym is best.
What you will not see here is me telling you the best way to exercise. What I will tell you is that as long as you make the effort (see key point #1 above) you will reap health benefits (such as lower blood pressure, reduced risk of diabetes, a better state of mind, improved cardiovascular health, and lower cholesterol).
A few tips will get you on your way to wellness
1) Stop procrastinating and making excuses.
2) Choose an activity you enjoy doing. If you are having fun, exercise seems less like a chore and more like something you will look forward to doing.
3) Get a friend or family member to exercise with you. You will enjoy it more and can encourage each other to stay motivated and be consistent.
Nutrition
As with exercise, there is no “one size fits all” approach to nutrition. Many people look for a magic pill or a supplement that will fill some unmet need in their body. Others seek out special diets, or go organic, macrobiotic, or vegan.
The best advice is difficult to generalize. Each individual patient will be in a different nutritional status depending on their medical condition (early or advanced HIV) as well as what they eat on a day-to-day basis.
For those people in overall good health, the same advice healthcare providers give their HIV-negative patients applies. Consume calories, fat, salt, and junk food in moderation. Avoid saturated and trans fats. Read nutritional information labels on prepared and packaged foods carefully to look for hidden but avoidable calories, salt, and fat. Limit your serving sizes and consider eating more frequent but smaller meals. Stop eating when you are full (no need to clean your plate just because there is still food on it). If you are overweight or have a high BMI (body mass index), consider increasing your exercise and eating less. If you are underweight, consider eating foods with a higher density of calories per serving such as lean meats and fish in addition to multiple daily servings of fresh fruits and vegetables.
For those people in poorer health, recovering from illness or drug abuse, or with limited resources to purchase the often more expensive foods, dietary advice becomes more challenging. If your clinic or provider offers nutritional consultation with a licensed dietician, seek their advice. People living with kidney or liver disease require special diets, as do those with other co-morbid conditions such as diabetes or heart failure. In general it is good advice for this group to add to a regular diet with dietary supplements such as Ensure or Boost or other high calorie/high density after-meal drinks (but ask your provider before adding these to your meals, especially if you have other medical conditions beyond just HIV). I am also a believer that you cannot ever eat enough fresh fruits and vegetables.
I am asked about nutritional supplements on a daily basis. While there are limited data available, I believe a basic generic over-the-counter multivitamin is a reasonable addition to eating the right foods. Vitamin supplements should not, however, be used as a replacement for eating properly.
Beyond a basic multivitamin, I do not encourage patients to take other kinds of supplements. It is probably safe to say some or most supplements are relatively harmless when taken as directed on the bottles. However, some things that seem harmless can actually be harmful or downright dangerous.
For example, garlic tablets (often used to lower cholesterol or “thin the blood”) have been shown to reduce plasma levels of some protease inhibitors. St. John’s Wort (used as a “natural” antidepressant) can also lower levels of protease inhibitors. More concerning are those supplements with effects we do not yet know.
There are literally thousands of websites advertising nutraceuticals and other types of pseudo-scientific sounding products making a variety of claims for improving your health. Most of them tout their own “clinical studies” or even worse, testimonials as to their benefits.
As soon as I read testimonials instead of university-caliber rigorous clinical studies that are FDA and peer-reviewed, it is a giant red flag that someone is out to separate you from your money. I believe it was P.T. Barnum who put it best: “A fool and his money are soon parted.”
Most of these so-called healthy alternatives are very expensive. More importantly, almost none of them are regulated by the FDA to confirm that they contain what they claim, nor are they tested for safety or effect. Some contain herbs and other ingredients that may be imported from countries that do not regulate those industries either. You might be consuming harmful amounts of pesticides, heavy metals, or counterfeit ingredients. My advice is do not ever take one of these products until you have discussed the pros and cons with your provider.
Certain micronutrient deficiencies can be harmful if undetected. Examples include iron deficiency (may lead to anemia), B12 deficiency (may lead to neuropathy), and vitamin D/calcium deficiency (may lead to osteoporosis). If your provider has reason to suspect you have a micronutrient deficiency, there are blood tests available to confirm it. In those special cases, additional supplements may be necessary to correct the shortfalls. It is important to note that with a good overall diet, most of these conditions are uncommon and will not require extra supplementation.
Lastly, as with anyone else, always wash your hands before preparing food. Always thoroughly wash fruits and vegetables. Use separate areas of the kitchen for preparing meats or other uncooked animal products. Avoid cross contamination by washing your hands again after touching raw meats. Use separate utensils, pots, and dishware for raw and cooked foods.
Mental health
Part of every routine visit to your provider should include an assessment of your mental health. Hidden psychiatric concerns such as depression, anxiety, addiction, and other issues can be easily missed.
As a patient, you should feel comfortable discussing anything with your provider, and that includes how you are feeling, not just “medical” concerns. If you’re a medical provider, you should make it a point to bring these subjects up as a part of the review of systems. Unrecognized mental health problems often lead to serious consequences such as missing doses of medications, missing appointments, reduced quality of life, relapse into substance abuse, and even suicide.
Many patients are what I like to call “doctor pleasers.” These are the ones who come to the office and when I ask, “How are you doing?” they sit forward, look me in the eye, smile, and say, “Great, doc!” They don’t want to complain about anything because they don’t want to let me down or burden me with their problems.
This is unfortunate because it is my job to be burdened. Sure, it makes the visit a lot faster and a lot less work for me, but that shouldn’t be the goal of a provider-patient encounter. As a patient, make sure you get your money’s worth at every visit.
Prevention with positives
Every HIV-positive patient should have a complete assessment of their vaccination history. In addition to all the childhood vaccines, HIV-positive people should have up-to-date tetanus, pneumococcal, hepatitis A and B, and MMR (measles/mumps/rubella). Further, annual TB screening with a PPD or quantiferon testing should be performed. If you have had a positive TB test in the past, your provider will order an annual screening chest X-ray. If you are a female, ask your provider about the new HPV vaccine. Some providers may also be considering this vaccine for men although there is not yet a formally approved indication in males. In select cases, vaccines for varicella zoster or meningococcal may be appropriate.
In serodiscordant couples (one partner is HIV-positive and the other is HIV-negative) safer sex with barrier precautions such as condoms and dental dams is essential. This is not only to protect the HIV-negative partner but for the positive partner as well. There are plenty of other sexually transmittable diseases out there that can be spread through unprotected sex. The list is long and includes syphilis, hepatitis A, B, and C, herpes, genital warts, gonorrhea, Chlamydia, LGV, and others. Either partner can spread these diseases to the other. In some cases, an STD may manifest in an unusual or more severe form, and be more difficult to treat, in an HIV-positive person.
In couples where both parties are HIV-positive, all of the above applies. In addition, I am often asked whether HIV can be re-transmitted between people who already have it. The simplest answer is yes. While this occurrence is presumed to be rare, it has been documented. The most serious concern in these cases is when one person transmits a strain of drug-resistant virus to their partner. The recipient may or may not have the same resistant strain and this may have serious implications in treatment.
Lastly, your provider should also be performing all the other age-appropriate preventative screening measures their HIV-negative patients receive. This means Pap smears, prostate exams, cholesterol checks, blood pressure screening, colonoscopies, and more. If you aren’t sure if you are due for these tests, ask.
Summary
Remember, wellness is more than just taking pills and keeping appointments. It is a wholistic approach to improving and maintaining a good quality of life. It involves exercising, eating right, protecting yourself and your loved ones from preventable illnesses, and keeping a healthy outlook. All of these issues require an effort on your part and are not always fun or easy. But the rewards to your commitment to wellness will be tangible and long-lasting.
For those of you who would like additional information, there are numerous legitimate resources available for free on the Internet. Some of my favorites include www.thebody.com, www.aidsmap.com, and www.cdc.gov. Be aware that some Internet resources are sponsored by pharmaceutical companies, nutraceutical companies, or others who may be pushing their own personal agendas. If you are unsure of the legitimacy of something you read online, print it out and bring it to your next appointment!
Chad Zawitz, M.D., completed his Infectious Diseases Fellowship at Rush University Medical Center, Chicago in June 2004, and started as attending physician at Cermak Health Services (Cook County Jail) in July 2004. He has been indirectly involved in HIV care since 1995, and began caring directly for HIV-positive patients as a senior internal medicine resident at University of Pittsburgh Medical Center in 2001-2002. At Rush during his fellowship, like all Infectious Diseases fellows, he had his own HIV clinic patients at the CORE Center (a joint venture outpatient HIV hospital associated with Rush and Cook County Hospital) for the past two years prior to starting full-time at the jail. |
