Second Thing: Things You Might Do Wrong (Draft)

The Second Thing is things that encourage HIV to replicate. There are two categories here, things we’re exposed to and things we put into our bodies.

Excessive exposure to sunlight (or tanning lights, sorry, no way around it) activates latent HIV in the skin. Bet your doctor didn’t tell ya that one, but it’s been well-known since the early 90s or earlier. And that’s an easy one to control. Sunscreen may or may not help; I haven’t found any research on it yet. However, it can’t hurt.

Something which requires a little more discipline is management of inflammatory processes. By this, I don’t mean the swelling you get when a chunk of the ceiling falls on your head; I mean body-wide immune responses. These responses include the production of tumor necrosis factor-alpha (TNF-a) and other inflammatory cytokines.

In the presence of TNF-a, HIV replicates at a greatly accelerated rate. Therefore, we want to reduce TNF-a production.

Inflammatory cytokines also activate CD4 cells inappropriately. So? CD4 cells are only vulnerable to infection by HIV when they are activated. Reducing production of inflammatory cytokines should reduce inappropriate and unnecessary activation, thereby limiting the number of cells getting infected.

So, what do we do about these inflammatory cytokines?

We look at the sources and work on controlling the triggers that induce cytokine production. Here are some, though I’ve no doubt there are more:

Allergies: Allergies are an inappropriate immune system activation involving an inflammatory response to pollens, dust, etc. It’s been documented since the 80s that people with severe allergies progress more rapidly than those without allergies; my own experience and that of another I’ve spoken with suggests that the effect can be managed, which is good . . . but the impacts of allergies on your immune system and on HIV hit hard and fast.

Here’s the story (yep, anecdotal evidence, not research):

In both our cases, we moved to places where we had significantly more allergic responses (he to Seattle, me to Phoenix). At the same time, viral load increased and CD4 count fell. Not hugely in either case, but by a significant amount.

In my case, my viral load rose from 976 copies/mL to over 12,900 copies/mL, and my CD4 count fell from the high 700s to the low 600s. More importantly, my CD4s fell to a 28 percent, well below normal.

He left Seattle, and his (still unmedicated) numbers returned to normal. I started using Rhinocort to help reduce the reaction, and also started allergy shots. The night sweats which started a few weeks after I moved to Phoenix had faded away after about a month of using Rhinocort; however, I decided to relocate to Oregon within three months of moving to Phoenix, and thanks to some mix-ups with insurance did not have labs done again until December of 2006. My viral load had dropped back to 1,664 copies/mL, and my CD4 count also returned to normal, at 780 and 34%.

Because of the gap in testing, I do not know precisely how rapidly the issue resolved.

I do know that allergy shots take months before they start to have a significant impact on the reaction, and about three years to complete the cycle.

Oxidative Damage: Oxidative damage is damage caused to cells by free radicals. You’ve heard of them in all the “heart healthy” business. Well, guess what? They’re not just a partial cause of aging, they also cause the body to react with lots and lots of inflammatory cytokines!

A combination of two approaches to managing oxidative damage can reduce inflammatory cytokine production. The easier of the two is to increase your antioxidant intake. Antioxidants include the A/C/E vitamins, Coenzyme Q10 (CoQ10), certain amino acids, and other supplements. They’re marked in the listing (to be added) by function. Some are cheap and readily available at grocery or drug stores. Some are less cheap and require a trip to vitamin stores. Many may also be purchased online through houstonbuyersclub.com.

Antioxidant intake can also be increased through your diet, getting as many servings of fresh or minimally-processed fruits and vegetables a day as you can (6 is a good target!).

The other method of managing free radicals (and oxidative damage) is control over negative factors.

Smoking is not just bad for your lungs . . . ‘Nuff said.

Also, deep-fried food isn’t just a great way to pack on the calories. Oils go rancid rapidly at high temperatures; using some olive oil in a stir fry is fine, since you’ll use it once and discard it. But your local fast-food joint uses the same oil, heated to a few hundred degrees, for days or weeks on end . . . Would you like free radicals with that? Limit intake of anything that’s been deep-fried.

Glucose Levels: As you go through the day, your blood glucose level rises and falls based on what you eat. Your doctor probably does glucose level tests when you have lab work done; this may or may not be a fasting test. Either way, it’s giving a baseline blood glucose level. The issue with blood glucose level comes when you eat; depending upon how high the foods you choose inflate your blood glucose level above that baseline, the body’s response can be quite intense, and have repercussions on immune function.

Thus far, I’ve only found solid research on sugar consumption, which demonstrated that consumption of 100g of sugar (a Coke has 39g, for comparison) reduced natural killer cell activity (a type of immune cell) by 40% for 5 hours.

Ingesting sugar causes a rapid rise in your blood glucose level. This causes your body to release insulin to balance out blood sugar; hence the sugar rush and crash. Guess what’s an inflammatory response and includes the release of bunches of those nasty inflammatory cytokines? If you guessed excessive insulin response, you win the prize!

What’s the prize? The realization that things which cause a rapid blood glucose rise do you harm and should be avoided.

How do we know what causes blood glucose to rise? Well, you could get a blood glucose monitor (the sort diabetics use) and carry it with you, then test your blood glucose beginning at the time you eat, then every 15-20 minutes thereafter for a couple of hours, and see what causes a significant rise and what doesn’t . . . or you could use other people’s research on the Glycemic Index and Glycemic Load, since they already did that for you.

Here’s a surprise: Eating a baked potato will cause a far higher and faster rise in blood sugar than eating a serving of ice cream. That doesn’t mean you should throw out all your potatoes and stock up on Ben & Jerry’s; it just means learning that simple (the sugar in ice cream) vs. complex (the starch in potatoes) carbohydrate isn’t all there is anymore. The speed with which certain foods are converted to glucose and hit your bloodstream, and how you can manage even eating high-GI foods without sending your blood glucose level skyrocketing, is information you need.

As a starting point with diet, I’d definitely pick up a copy of The New Glucose Revolution. Personally, I think they’re a bit too liberal on use of higher-GI foods; but maybe I’m unnecessarily restrictive. Dr. Barry Sears’ Anti-Inflammation Zone (he’s the author of the Zone diet, this is a second-generation book) is also very good, addressing issues beyond glycemic index and load. Things like:

Inflammatory fatty acids: Something not addressed in The New Glucose Revolution is the problem of the human dietary imbalance of Omega-3 vs. Omega-6 fatty acids. (Huh?)

Omega-3 fatty acids have an anti-inflammatory effect. They come from a number of sources, but are at their highest concentrations in fatty fish and flaxseed. I take 4000 mg of fish oil a day. (It’s cheap.) I also try to have tuna or salmon at least twice a week. Also, I use extra-virgin olive and expeller-pressed canola oils exclusively for cooking.

Omega-6 fatty acids have an inflammatory effect. They’re found in most vegetable oils, like corn oil, soybean oil, or sunflower oil. A recent (2006!) study confirmed that the use of margarines (vegetable oil-based) increased inflammation in asthma sufferers. Switch to butter if you can’t do olive oil on everything, just use it sparingly. It still has a lot of saturated fat and cholesterol, but has not been shown to have such an inflammatory effect.

Things we do that suppress immune function: There are a few things we do which we generally know aren’t good for us, but we do them anyway.

Alcohol is an immunosuppressant! I used to drink a lot more than I do now . . . a drink or two with dinner, going out (and drinking) once or twice a week . . . Then I read a study result indicating that as little as three drinks over a two-day period has a measurable immunosuppressive effect (one drink alone appears not to have such an effect), and cut back. Nowadays, I limit myself to one most of the time, and that one isn’t all that often.

Drugs are immunosuppressants! By this I mean recreational drugs. The only one I’ve done any searching on which doesn’t appear to have an immunosuppressant effect will still do lung damage and introduce free radicals . . . yep, marijuana. So if ya gotta have pot, gently sautee it in olive, canola, or flaxseed oil, discard the herb, and add the oil to a nice salad as a dressing. Or find some other culinary use for the oil. (I hear butter works just as well. Hmm, marijuana butter?) If you must smoke it, at least use a water pipe to cool the smoke, moderating the amount of lung damage.

Ecstasy, crack, coke, meth, etc. all have documented immunosuppressive effects. Best way to manage them is abstinence; if you simply must use them, make it infrequent.

Smoking is immunosuppressive! Not only does smoking introduce free radicals and do lung damage, but it also has documented immunosuppressive effects. It also makes it harder to do the GOOD things you want to do . . .