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Fats & Oils
A moderate intake of good fats is necessary for health. However, because of the fat malabsorption experienced by many and the diarrhea that can result from that, it will often need to be limited. Some fat is necessary for health, but because of the fat malabsorption experienced by many and the diarrhea that can result from that, it will often need to be limited. For those also living with hepatitis C, keeping fat intake low will be even more important since studies have shown a higher risk of progression to cirrhosis in those with higher fat diets. In addition, for those at particular risk of developing cardiovascular disease (due to the blood fat-elevating effects of HIV treatment, especially when combined with other heart disease risk factors), keeping fat intake at moderate levels will also be very important. And for everyone, fat should come from healthful sources.
This means focusing on natural fats, especially the monounsaturated fats found in extra virgin, cold-processed olive oil (which is probably the best overall choice), as well as in canola oil, avocados, peanuts, cashews, almonds, and most other nuts;. Cold-water fish (such as wild salmon and sardines) contain the heart-healthy omega-3 fatty acids that are another good kind of fat. So eating modest amounts of fish can provide the natural anti-inflammatory effects of fish oil, although it's important to avoid fish that may be high in mercury (swordfish, tilefish, shark, and king mackerel). It's best to limit saturated fats (for example, by choosing lean cuts of meat or low-fat dairy products).
Perhaps most important of all is to avoid the bad fats that are far too common in the North American diet. In particular, it is very important to completely eliminate "partially hydrogenated" fats from the diet. Hydrogenation is a process that uses heat and chemicals to change the structure of the fatty acids in vegetable oils so that the oil is solid at room temperature. For example, hydrogenation is how liquid corn oil is converted into solid margarine. You will see these partially hydrogenated fats referred to as trans fats, a word that refers to the change from the normal chemical cis bond found in the fat to the trans bond that is created with hydrogenation. Don't worry—you don't need to study organic chemistry to understand this. Just know that these trans fatty acids may contribute to blocking some of the body's normal chemical processes, including those related to fat metabolism. All the researchers who have studied this believe that these artificially created fats have many negative health effects.
Partially hydrogenated fats are found in countless foods. These include margarine, shortening, most standard breads, crackers, cookies, other baked goods, many condiments such as mayonnaise, most commercial salad dressings, and some processed meats and snack foods such as potato chips, corn chips, ice cream, and French fries. It is crucial to read labels carefully in order to eliminate these unhealthy fats. If the words "partially hydrogenated" appear anywhere on the label, do not eat that food. Seek out the brands of foods that have eliminated these bad fats in favor of healthful, natural ones. Luckily, there are many whole-foods companies that manufacture fat-healthy foods of all kinds. When eating out, be aware that most "fast-food" establishments use partially hydrogenated oils in their cooking. If you just have to have burgers and fries, you'd be better off making them at home from healthful ingredients. Even in better restaurants, it's a good idea to ask what kinds of fats they use in cooking and what's in the bread they put in front of you.
In general, try to make sure that you're consuming the fats that nature made. That lovely still-green olive oil not only makes great salad dressing, but is also wonderful to spread on bread. You can even use it for sautéing garlic or onions or vegetables, as long as you keep the temperature fairly low since it has a low smoke point. Just don't overdo overall fat intake if you are experiencing the effects (diarrhea and gas) of fat malabsorption, or if you are coinfected with hepatitis C, or if your blood fats are elevated and putting you at risk of heart disease.
When looking at the possible ways to reduce fat, remember that much of it is "hidden." Meat (other than very lean varieties) and dairy products other than those made from skim milk (including cheese and cream and yogurt and ice cream) are all loaded with fat. Breakfast and luncheon meats, including bacon, sausage, bologna, pastrami, and so on, are very fatty. In addition, a huge percentage of snack foods are fat-loaded, including most chips, many crackers, many cookies, many granola bars, many candy bars, most hot dogs, peanuts, nuts, and so on. And, of course, the fats found in salad dressings and peanut butter or other nut butters and many sauces can add huge amounts of fat calories if you overdo them. Fried foods of all kinds (burgers, French fries, fried chicken, fried fish, fried or deep-fried vegetables, and so on) are often lethally high in fat. And last but not least, the addition of fatty products such as butter or vegetable oils or mayonnaise or cream or whipping cream or sour cream can dramatically increase the fat content of any dish.
Relatively simple dietary and food preparation changes can significantly reduce the fat content of your diet:
- Bake, broil, or grill your meats, poultry, or fish instead of frying them.
- Use skim milk and skim milk cheeses and yogurt instead of whole milk or the cheeses or yogurts made from it.
- Avoid high-fat breadstuffs like croissants, doughnuts, muffins, and most cornbread. Use whole-wheat pita bread or low-fat whole-grain breads instead. If you're making your own baked goods or sauces, use unsweetened condensed skim milk in place of cream.
- Avoid high-fat sauces and gravies and butter, substituting herbs and other seasonings to improve the flavor of foods. Since, unfortunately, removing the fat from dishes often seems to remove a lot of the flavor that we're all accustomed to, try using salsas, roasted garlic or shallots, flavored vinegars, chicken broth, and various hot sauces to spice up low-fat dishes.
- To thicken a sauce or a soup, use pureed white beans, instant mashed potatoes, or cornstarch and skim milk instead of the heavy cream that so many recipes call for.
- To make mashed potatoes, mash them with fat-free chicken broth instead of butter and milk.
- Avoid fried potatoes or other vegetables, substituting steamed or baked versions.
- To "sauté" foods like onions, garlic, mushrooms and so on, use water or poultry broth instead of butter or oil. Alternatively, just "sweat" such foods. Place the chopped onions or garlic in a frying pan and use moderate heat just until they begin to brown around the edges. Then pour in stock or vinegar to deglaze the pan.
- Prepare your own popcorn, using skim-milk grated cheese and various seasonings instead of fat as the topping.
- When you just have to have a little fat for flavor, use toasted sesame oil or other strongly flavored oils. A little of those goes a long way in increasing both the appetite-stimulating smell and flavor of foods.
The one caution about all this discussion of fat is that, as with all things, you shouldn't carry fat avoidance to an extreme. What we are talking about here is a whole foods diet that contains moderate amounts of the good kinds of fats. We are not talking about a diet with no fat at all. In the concern to educate people about the need for diets that are lower in fat than the American norm (which is extremely high in fat, usually of all the wrong kinds), it seems that it is sometimes forgotten that fat is necessary at appropriate levels and in appropriate forms.
Essential fatty acids are just that—essential. Both the omega-3 and omega-6 fatty acids are very important for human health. When levels of fat intake drop so low that the levels of essential fatty acids in the body are compromised, there can be many negative health consequences, including skin problems, neurological problems, energy problems, and suppressed immunity.
In addition, fat is the body's storehouse of energy. You need reasonable amounts of it stored in your body. And some fat in the diet is required for the absorption of the fat-soluble vitamins A, D, E, and K. So, in your attempt to decrease intake of unhealthful fats, don't throw the baby out with the bathwater. A reasonable intake of moderate amounts of healthful fats is what is wanted. Extremes of fat intake in either direction, too much or too little, are not desirable.
For those in whom fat malabsorption causes or contributes to diarrhea, the use of pancreatic enzyme tablets which contain lipase, the fat-digesting enzyme, taken with all fat-containing meals or snacks may help. Recent research has shown a significant increase in stool consistency in those given Digestive Care Inc.'s Pancrecarb, a pancreatic enzyme formula that is enteric-coated (to ensure that it reaches the small intestine where the enzymes are needed) and contains bicarbonate (to ensure an optimal pH level in order to improve the usefulness of the enzymes). This product, available by prescription, has an FDA indication for fat malabsorption. There are also many anecdotal reports that indicate that this product may greatly reduce the gas and bloating that fat malabsorption can cause.
Sweets
Concentrated sweets should also be limited. The other item at the top of the food pyramid, concentrated sweets, should also be limited. The problem is that too many people consume too many nutrient-poor snack foods and desserts—often loaded with excessive sugar and fat—and then aren't hungry for all the nutrient-rich foods that they should be eating. The end result is a diet loaded with empty calories that, to say the least, does not promote health.
For people experiencing insulin resistance—now being seen in more and more people on HIV treatment—and the elevated blood sugar problems that may result from that, limiting sweets while aiming for foods lower on the "glycemic load" scale may be even more important. There's more information on the glycemic load in "More on Carbohydrates."
No one expects perfection here. The fabulous dessert or other now-and-again treat is a reasonable exception for most people. The bottom line should simply be to try to make both sweets and high-fat foods occasional treats instead of a major part of your diet.
Credits
This lesson was written by Lark Lands, a longtime HIV disease treatment writer and educator. Her informative website is www.larklands.net. |
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