stristrive to thrive ve to thrive - nelson vergel · stristrive to thrive ve to thrive ......

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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


LDL cholesterol

HDLcholesterol


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Lipid profile due HAARTLipid profile due HAART


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

surgeonsurgeon

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”

www.amazon.comwww.amazon.com or any bookstoreor any bookstore

100 % of proceeds fund non100 % of proceeds fund non--profit wellness centersprofit wellness centers

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


stristrive to thrive ve to thrive - nelson vergel · stristrive to thrive ve to thrive ......

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