compiled by Martin Flynn
News
BONE LOSS HOPE FOR PEOPLE WITH HIV
People
living with HIV are a 100 times more likely to develop bone death,
known as osteonecrosis, than the rest of the population.
It occurs when the bone’s blood supply is disrupted and often results
in painful decay and loss of bone, particularly of the hip joint. Some studies
suggest it may be associated with use of HIV drugs.
In one study, four per cent of positive people were found to have osteonecreosis
of the hip, the March edition of The Journal Clinical Infectious Diseases
reported.
Post menopausal women and those who had used corticosteroids or done heavy
weight training were found to be in greater danger of bone loss.
Last year, pop star Andy Bell told PN he had to have a double hip replacement
because of the condition, but after surgery and recuperation he could dance
around the stage once again with no pain.
February’s 14th Conference on Retroviruses and Opportunistic Infections
(CROI) in Los Angeles heard how one particular new drug works well to improve
bone mineral density.
Alendronate, brand name Fosamax, is thought to work by slowing the reabsorption
of bone by cells called oestoclasts.
Patients with HIV and bone loss who took the drug over 48 weeks with calcium
and vitamin D supplements showed significantly improved bone density in the
spine, leg bones and hip joints.
However it is unlikely the drug will be made available to HIV positive patients
in the UK before next year at the earliest.
• 14th CROI 2007, Abstract 42, ACTG 5163.
YOU’VE GOT
TO HAVE SKIN...
...It
keeps your outside out and your inside in, as the song goes. But
with skin you can get a whole lot more too.
New York School of Medicine has found human skin is a ‘virtual zoo’
of bugs and a small patch of skin contains many hundreds of different species
of bacteria, many previously unknown to science.
Skin is the body’s largest organ and acts as a natural barrier to infection.
Daily cleaning removes most of the germs and HIV positive people are advised
to wash their hands several times each day to prevent any bugs getting into
the body.
“The microflora in your skin is important to keep your skin healthy
but these days people tend to take more showers and use chemicals,”
Dr Richard Bojar, from the New York Skin Research Centre, said.
“The ancient Romans wiped on olive oil and wiped it off which gives
you very good skin,” he added.
GARLIC DEBATE RUMBLES
ON...
Whether or not eating extra garlic benefits people living with HIV is again
in the news this month.
Used across the world for its natural antibiotic effects, garlic has also
been lauded for its ability to lower levels of cholesterol.
But new research from the Archives of Internal Medicine suggests allicin,
the active compound in garlic, does not significantly lower bad LDL cholesterol.
This contradicts conclusions from 90 other studies.
Judy O’Sullivan, of the British Heart Foundation, said: “This
small study shows eating raw garlic or taking garlic supplements has no benefit
for the heart. However, eating garlic as part of a balanced diet will add
variety and flavour, and it is a healthier alternative to salt.”
HIV experts have warned eating too much raw garlic could significantly lower
the absorption of some antiretroviral drugs including PIs and non-nukes.
Roy Kennedy of Stellenbosch University told PN: “Eating large amounts
of garlic can make certain antiretrovirals up to 50 per cent less effective.”
Whether garlic interferes with the pathways where HIV drugs are broken down
in the liver has been suggested many times but has yet to be proved.
The debate was further muddied by comments from South African health officials
that garlic and lemon juice are just as effective against HIV as antiretroviral
drugs.
Feature All
stressed upor do you just need to get a grip?asks John Clarkson
“I
can’t take it.” “I need to chill out.” “Things
are getting on top of me.” Familiar? Perhaps you are suffering from
stress.
Many of us experience this feeling at some point in our lives, but few recognise
it as the effects of stress and fewer still will take conscious steps to remedy
it.
Some die-hards still dismiss stress as a modern malady of a pampered society.
True, its effects have only been measurable since the 1950s, but, although
not completely understood, there is little doubt it exists and affects us
all.
What is stress?
Stress is the body’s response to a perceived threat. In readiness to
run away from or attack the threat, the body secretes the hormones adrenalin
and cortisol into the bloodstream, increasing heart beat and blood pressure,
and directing blood away from systems such as digestion to ones in more immediately
need like large muscles.
This ‘fight or flight’ response is what has ensured our survival
over millions of years. These days we are unlikely to need to square up to
a woolly mammoth in the middle of the night but the mechanism remains. Nowadays
it is more likely to alert us to psychological dangers or perceived concerns
about the future.
Stress can be useful. It drives us on to great achievements and help us overcome
difficult events like moving, births and bereavements. It can also be fun.
Why do we like horror movies and roller-coasters?
Problems start when the stressor, the thing causing stress, is a long-term
fixture in your life; a bad marriage, ongoing debts, problems at work and,
of course, the stress of living with a chronic medical condition, such as
HIV.
Left unaddressed, continuous stress drains your body’s resources and
can lead to:
• difficulty sleeping and waking
• increased irritability and a heightened sensitivity to criticism
• excess drinking and smoking
• indigestion
• depression
• sexual dysfunction
Many people believe stress plays a part in illnesses such as heart disease
and cancer though this is unproved. However, in 2002 the Health and Safety
Executive published figures showing about 40 per cent of all sickness was
stress-related, accounting for a whopping 13.4 million sick days per year.
Stress
and HIV
Proving a direct connection between stress and HIV progression is hard because
of the complicated relationship of the biological mechanisms involved. One
study found “faster progression to Aids was associated with higher cumulative
average stressful life events”, but that is just one study.
Dr Pepe Catalan, consultant in General Hospital Psychiatry at Chelsea and
Westminster Hospital, said: “There is little evidence these factors
influence significantly HIV progression. One possible problem for those who
feel stopping HIV progression can be achieved by psychological means is if
his or her disease progressed there could be a tendency to blame oneself for
failing to control the infection. Clearly though, leading a healthy, fulfilled
life and maintaining a positive attitude has to be a good thing, whether or
not it is associated with a better HIV prognosis.”
De-Stressing
Removing the causes is the most effective way of treating stress. It’s
not always possible, but hiding from or ignoring problems can make them appear
scarier than they actually are. Facing up to fears, we often discover they
weren’t quite as big as we thought. There will always be a certain amount
of stress in your life so try these to limit its impact:
Dim the lights - over-illumination, especially from fluorescent
lights has been shown to cause stress.
Get touched - massage promotes relaxation and circulation
and temporarily turns off the effects of stress.
Take tea - drinking coffee produces all the same symptoms as stress;
increased heart rate, blood pressure and stress-hormone levels. Tea contains
the amino acid theanine, which reduces them and creates a sense of well-being.
Stub it out - like coffee drinkers, many smokers think fags reduce
stress, but in reality it increases it by constricting the blood vessels,
increasing blood pressure.
Say a little prayer - whatever the reason, prayer has been shown
to reduce stress regardless of your deity. Atheists can take solace from the
fact they think they are right.
Be nice to yourself - disconnect the phone, put on Barry White, light
candles, run a bath, add essential oils, hop in. Partner optional.
Food for thought
SALT
We’re told to cut it out, but why is salt so bad for us?
Sea,
table or pink Himalayan; all salt is basically sodium chloride. We’ve
been sprinkling it since the Iron Age to preserve food and make it taste good.
It’s vital in the body for nerve conduction, muscle contraction and
the balance of water in your cells.
Surely a bit won’t harm?
We are told to cut down because salt has been linked to high blood pressure
(hypertension), which can lead to stroke and heart attack. But even the Food
Standards Agency’s (FSA) advisors accepts opinion is divided.
Some studies found certain people were more prone to the harmful effects than
others. Black people are more likely to be ‘salt-sensitive’ than
white, which explains the higher incidence of hypertension at an earlier age
in black people.
You don’t have to be Einstein to realise people who eat salty ready-meals
and take-aways are also eating loads of fat and little fresh fruit and veg.
This too may make them prone to high blood pressure. Perhaps salt’s
role in high blood pressure has been overstated but there is little doubt
most of us eat too much. Like most foods, moderation is key.
Which foods?
Only five per cent of the salt we eat occurs naturally in food. A staggering
75 per cent is hidden in processed foods; ready-meals, biscuits and cakes,
sauces, tinned veg and pulses, soups, burgers, sausages, crisps; you can’t
even make bread without salt.
Inconveniently some labels give salt content and some give sodium. 1g salt
= 0.4g sodium but here’s an easy guide to whether food is high or low
in salt.
| 1.25g salt 0.5g sodium and above |
High Salt content |
| 0.25g salt 0.1g sodium and below |
Low Salt content |
The FSA recommends babies have no more than 1g (0.4g sodium) per day. This
rises with age to under 6g per day (2.4g sodium) for adults. The minimum is
only 500mg (0.5g) and deficiency is rare.
Our expert* says:
A high salt diet increases your risk of developing hypertension, which affects
about a third of us. The Government recommends reducing salt intakes to 6g
per day, but the optimal intake is thought to be 4g, though most of us eat
more than double that. Reducing salt intake to 6g per day would lead to a
13 per cent reduction in stroke and a 10 per cent reduction in ischemic heart
disease.
Dietary Approaches to Stop Hypertension (DASH) studies provide convincing
evidence of the benefits of a balanced, low sodium diet. To follow the DASH
diet, eat at least seven a portions of fruits and veg a day, low-fat dairy,
fibre, nuts, seeds and legumes and lean meats and fish.
Why not try...
REDUCING YOUR SALT INTAKE
Adding salt to food only makes it saltier, not tastier. Use good quality,
fresh ingredients to get the natural flavours coming out
Add more herbs and spices, garlic, citrus, wine and vinegars
Marinade meat and fish to add flavour
Roasting vegetables intensifies their flavours
Taste food before adding salt
Use low-salt stocks, available at most supermarkets
Season pasta, scrambled egg etc with black pepper instead
*Karen Klassen is lead HIV dietitian at St Mary’s Hospital, London
