How to Eat if You Want to Die of AIDS

Townsend Letter for Doctors and Patients, Oct, 2001 by Stephen Byrnes

Eat Up: Nutrition Advice and Food Ideas for People Living with HIV and AIDS

Charlie Smigelski

Tufts University; 1997

As a journalist who has written extensively about HIV and AIDS, as well as a practitioner who has worked closely with people diagnosed as HIV antibody positive, I was keen to look at this book. Smigeiski, a Harvard-trained dietician who worked for a while on the Framingham Heart Study, runs the HIV Nutrition Coalition with several other RDs from the Boston area. This 57-page handbook is apparently given out to their clients.

I pity the poor souls who will have to suffer through, with, and because of this book. Smigeiski opens by saying that nutritional needs for those who are HIV are unique, that such people need more protein "to fight HIV," and to eat as many "healthy foods" as possible. But Smigeleki's idea of what makes up "healthy food" is standard dietician fare: the Food Pyramid with "tons" of grains (whole wheat if possible - pg 15) and foods that are "low fat, high fiber, whole wheat, dark green, and low sugar" (pg 6). This is his advice if one is asymptomatic.

However, if one has fought off a major infection, Smigelski recommends foods that are "buttery, sweet, rich, creamy, fatty, fried, syrupy, heavy" (p. 6) to put back lost weight and muscle mass. Further, if one is fighting a major infection, he recommends "candy, vitamins, and supplement drinks," if one is feeling "very sick and uncomfortable" (pg 6). He never explains how eating candy will help a sick body fight off an illness.

Smigelski offers two sample day menus on pages 16 and 17 for HIV s of different weights. Some of his food suggestions are: Wheaties, Cheerios, or Total for breakfast; Pretzels, potato chips, and soda with lunch; Milk or hot chocolate with Fig Newtons or other cookies for a snack; a slice of pie or cake (or three or four cookies) with milk or juice as a late night snack.

Other "easy food" suggestions are found on page 28 and include such nutrient dense dishes as: Doughnuts, peanut butter with Marshmallow Fluff, a 2" slice of Angel Food cake, and canned peaches.

Apparently, it's OK to guzzle entire quarts of fruit juice and Gatorade (pg 44) during the day, but not OK to put some extra butter on your Boiled Parsnips and Canned Pears (with 2 tsp of non-dairy creamer as an optional add-on item- pg 30) because it might be too high in fat!

On page 35, Smigelski gives food tips for people with diarrhea. Recommended are: white rice, Gatorade, Egg Beaters, tofu, gummy bears, Twizzlers licorice sticks, and gum drops among other selections. On page 36, Smigelski recommends MCT Oil as a fat option during diarrhea, but fails to inform his readers that excessive MOT Oil causes diarrhea.

More horrors await the reader on pages 43 and 44, where Smigeiski gives eight recipes for white rice for "when your intestines cannot handle milk, fats, and fiber." Page 44 contains advice for eating "when fatigued" and includes such nourishing options as: Canned chunky soups, candy, and Hungry Man Frozen Dinners. Additionally, after a bout of diarrhea, Smigelski recommends that people add Carnation Instant Breakfast (2 packets a day) to their beverages to help put back lost weight (pg 47).

For supplements, Smigeiski recommends a multi-vitamin! mineral supplement (among a few others), but suggests that it should be a brand like Theragran-M or Spectravite which are very low-potency. Such a supplement could not possibly supply an ailing body with any "nutritional insurance." His advice on antioxidant supplementation (absolutely critical when dealing with AIDS) is pitiful and woefully inadequate.

Perhaps the most despicable thing about the book is the fatalism that is brimming under the surface of almost every page. The fatalism that the reader, no matter how many food tricks he may pull or how many cans of Ensure he drinks, will die of AIDS. On page 4 Smigelski says, "As you know, HIV slowly destroys the immune system so that it cannot fight infections as well." Later on (p. 6), he reminds the reader that, "You will most likely need special drinks.... A tube-feeding might be necessary." One can only imagine the negative psychological impact of such horrific statements on an unsuspecting reader.

Instead of offering his readers choices for real nutrient-dense foods and easy ways to prepare them, Smigelski stays mired in the muck of TV dinners, high sugar sports drinks, sodas, and packaged convenience foods that are devoid of any life-giving properties. Instead of reminding his readers that virtually all of their diarrhea and other side effects come from the toxic, carcinogenic drugs that they are terrified into taking, and that they'd be better off not taking them at all, Smigelski offers an endless array of white rice recipes to "cope." Instead of offering his readers hope for the future and a sound supplement regime to stay on top of oxidative stress, Smigelski offers generic, synthetic vitamins and thoughts of death.

This book should have been titled: How to Eat if You Want to Die of AIDS.