Any suggestions on how to get rid of gut after starting meds

[Jordan]

I was diagnosed Feb 2014. And started meds (Stribild) March of 2014. My initial cd4 was 150 and my viral load was around 103,0000.
Before started meds i lost a lot of weight, which is what triggered me to get tested.
Upon starting meds I weighed approx 165 pounds. Since being on meds I am now approx 175-180 pounds.
It looks like most of my weight gain was in my stomach.
I like the weight that I've gained but I now have a very noticeable gut/stomach that family and friends (none know of my status) have commented about.
I workout/lift 3-4times a week for about an hour. Prior to loosing weight before my diagnoses I always had a muscular/athletic body.
My eating/dietary habits are fairly decent/clean.
I look strange, my arms and legs are muscular (although smaller than normal), but I have this very noticeable stomach.
Does anyone have any suggestions on what I can take to target/get rid of this stomach but without risking loosing weight in other parts of my body?

 

[Mocha]

Hi Jordan,

Welcome to the forum!

Built to Survive by Nelson Vergel (founder of ExcelMale.com) is one of the best books for the HIV-positive population (and anyone looking for body recomposition in general). It's an incredible resource and covers everything from Hormones to Nutrition to Exercise. I'm not an expert on the subject, but I believe what you're talking about is called lipodystrophy. The book covers that as well.

You can download it here: https://www.excelmale.com/forum/sho...lt-to-Survive-Medical-Use-of-Anabolic-Steroid

 

[Nelson Vergel]

Nelson's Top 10 Tricks for Fat Loss

By Nelson Vergel

ExcelMale.com

Get real. Ask yourself: What is getting in the way of my health? What excuses am I using to not start giving a damn? There is no perfect time to start. Do it now, even if it means one change per week in your lifestyle choices. You deserve to feel and look the best you can!

You cannot change what you do not measure!
Download a step counter (pedometer) app to your phone or buy one to carry with you all day. Research has shown that 10,000 steps a day keep people from gaining weight and may help those wanting to lose weight. It approximately equates to 3 miles. If by 6 pm you have not reached that goal, you can make up for the difference on a treadmill, walking the dog, walking to the store, etc. Read more on this.

Weigh yourself 3 times a week in the morning while on an empty stomach.

Get yourself a ring to wear on one of your fingers, or use the one you are wearing now; it's the best way to find out if you are inflamed or holding too much water. When tighter, you need to exercise to decrease inflammation and water retention.
If you have a progressive doctor who can refer you for a full DEXA body scan, good for you. This is the best way to know your body composition in every part of your body.

Change the way you drink and eat:
Avoid drinking sodas, fruit juices (eat fruit instead), more than two glasses of wine a day. Carry a water container in your car, office, and any place you hang out, and sip from it all day (you can add flavored Benefiber or Citrucell to that water if you need to drink something with flavor).

Also, avoid eating sweets, white bread, bagels, muffins, and most cereals (they are loaded with sugar and high-fructose corn syrup). Instead eat whole grain, dark-colored bread (if you have to), and never consume carbohydrates by themselves (adding good fats and fiber to carbs slows down glucose and insulin spikes in the blood that may predispose you to metabolic syndrome and fat gain). Watch a great lecture that will open your eyes to the effect of sugar on health.

Consume 20 grams of fiber (soluble and insoluble) per day. For most of us, this is hard to do unless we eat beans, nuts, and 4 servings of fruit and vegetables. Fiber improves insulin sensitivity, makes you feel full longer, keeps your gut healthy (friendly gut bacteria that produce vitamins love fiber), keeps you regular, and can lower the chances of getting colon cancer. Buy Citrucell or Benefiber, two over-the-counter products available in most grocery stores. Try to consume 12 grams of fiber a day from these supplements in water. You can also add them to soups, oatmeal, scrambled eggs, yogurt, water to sip all day at work, sauces, and home-made salad dressing.
To ensure that you have enough fruits and vegetables at home, buy frozen ones (frozen fruits and vegetables tend to be cheaper and loaded with vitamins since they are picked at their prime).

Follow a slow carb (low glycemic index) diet.
Twice a day, snack on almonds, pistachios, walnuts, and other nuts at work to get your good fats and fiber, and to make you less likely to cheat later. If you get tired of their taste, mix them with some dried fruit. Research has shown that people who eat nuts tend to have lower LDL cholesterol.

Avoid junk and fast food. The best way to do this is to have enough food at home and to bring lunch to work. Cook a lot of food on weekends and freeze meals in small containers you can take to work or heat up at home. Get yourself a slow cooker and use its enclosed cookbook to prepare warm foods that you can come home to. Do not sabotage yourself by bringing sweets and junk into your home. If you do, you'll eventually eat them (most of the time, in one sitting!).

Watch your cravings at night, when most people find it the most difficult to avoid over drinking alcohol or eating ice cream, cookies, and comfort foods.

Eat a large breakfast, a moderate lunch, and a small dinner. I know this sounds completely different to what most of us are doing every day.

Skipping breakfast makes you more prone to overcompensate by eating more calories late in the day. Your body has spent 7-8 hours without food and is starved for nutrients in the morning. Do not feed it sugar and white flour products at this important time, like many people are accustomed to doing due to being rushed. Eggs, oatmeal (the type that has no added sugar, and you can add whey protein powder to it!), Greek-style yogurt with nuts and fiber supplements, low-fat cottage cheese with fruit (if you're not lactose intolerant), almond butter sandwiches on multigrain (high-fiber) bread, and fruit are all good choices for breakfast.

For lunch have some soup and a glass of water first and wait 10 minutes to trick your body into feeling full faster. Grilled chicken with vegetables, tuna salad over greens and nuts, a Greek salad with sliced steak, and any Mediterranean food choices are good.

For dinner, fill yourself with stir fried (use olive oil!) vegetables and lean meats. Two hours before bed, you can have half an almond butter sandwich or yogurt with fruit. You will not be hungry and desperate with this diet!

Do resistance exercise with machines at the gym if you are a beginner, or weights if you have more experience. Here are some other exercise recommendations.

Get your hormones checked and supplemented if low
If you are having a hard time losing weight and you are doing all of the above, have your doctor check your blood levels of free testosterone and thyroid hormones (TSH, T3 and T4) (yes, women and men!). Low hormone blood levels can impair fat loss and energy levels required to exercise. They can also make your less prone to be motivated to follow a healthy regimen. Read more about testosterone here.

If you have access to a glucose tolerance test, take it. This test will determine how your body uses glucose for energy and compare it to a normal response. If you have impaired glucose tolerance, your doctor may want to prescribe metformin, an insulin sensitizer that may help people lose fat by helping their insulin work better at controlling blood sugar and metabolism.

If your belly is hard and you cannot pinch much fat, you may mostly have visceral fat. You may want to talk to your doctor about a new FDA-approved product for HIV-associated visceral fat called Egrifta(tesamorelin). Egrifta is a growth hormone-releasing factor that makes your pituitary gland make your own growth hormone. Growth hormone has been shown to help burn fat. If you do not have insurance, you can apply for patient assistance (more on Egrifta.com).

Drinking a tablespoon of apple cider vinegar before every meal has been shown to improve glucose tolerance and insulin response. Better glucose tolerance and lower insulin resistance can make it easier to lose fat. Read more on this.

Supplements:
Be careful with weight loss supplements since they are loaded with caffeine and stimulants that can raise your heart rate and blood pressure.

Take a multivitamin after breakfast and lunch.

Take Carnitine, 1,000 mg with breakfast and 1,000 mg with lunch; here's a study on Carnitine.

Find a support system that is there for you through all of your new lifestyle changes. Having an exercise/diet buddy is the best way to improve adherence to your diet and exercise program. Join groups online. Surround yourself with friends who support you all the way and enable you to succeed!

 

[Nelson Vergel]

Several treatments and approaches have been and are being studied to decrease visceral fat in HIV positive people:



Human growth hormone can lower belly fat, but not without side effects. Serostim (a brand of HGH) is approved to treat HIV wasting, but its side effects led the FDA to deny its approval for lipodystrophy. These included joint pain, edema (water retention), increased lipoatrophy and blood sugar increases. Its high cost and lack of insurance reimbursement (due to its lack of FDA approval) are also barriers to use. It requires daily or every other day injections under the skin. But it has been shown to decrease visceral fat by 30% in 6 months.


Tesamorelin (Egrifta) is a copy of a hormone that causes the pituitary gland to produce growth hormone. This is the only product approver by the FDA for the treatment of abdominal fat in HIV. Like Serostim, it requires daily injections under the skin but it seems to have milder side effects: mild edema, some joint pain, and a hypersensitivity reaction in 10% of people (sweating and rash). But it does not increase blood sugar or cause lipoatrophy, and it may lower triglycerides, a problem caused by some HIV meds. It has been shown to decrease visceral fat by 15% in 6 months.
Activists are concerned that its price will be high. This could cause insurance companies and Medicare to deny payment since it may be perceived as a cosmetic product. Also, it will be sold in the U.S. by Serono, the same company that sells Serostim. Serono has had poor relations with activists in the past, and was also fined over $700 million by Medicare for using fraudulent practices to induce some physicians to prescribe Serostim.


Leptin is another new contender in the search to decrease visceral fat. This hormone, discovered in 1994, is produced by fat cells. Leptin levels in the blood are generally proportional to the level of body fat. In the hypothalamus (the part of the brain that controls appetite), high levels of leptin suppress the appetite and stimulate fat-burning. Like Serostim, it is taken as an injection under the skin, but it requires two injections a day, though other doses may be studied in the future. In a study of eight men with HIV and lipodystrophy, visceral fat decreased by 32% after 6 months, with no change in subcutaneous fat. Bad (LDL) cholesterol decreased by 16% and good (HDL) cholesterol increased by 19%, with a significant decrease of triglycerides. Leptin was well tolerated but it decreased lean mass. Early, small studies have not shown leptin to have negative effects on blood sugar, as Serostim can. But activists are asking its manufacturer to do larger studies in people with HIV to determine if leptin is useful and if it will be cost-effective.


Metformin is a diabetes drug that at first showed promise in reducing abdominal fat. But later studies have not confirmed this, and have in fact shown that it may worsen lipoatrophy. However, in people without lipoatrophy who have glucose intolerance, metformin may reduce the risk of diabetes and therefore, abdominal fat. Its effects may be enhanced by exercise. Metformin improves insulin sensitivity, triglycerides, and fatty liver, but can cause diarrhea and weight loss (which may itself lead to a decrease in visceral fat). Some people have reported low blood sugar and dizzy spells, so users of this drug should have snacks at hand to increase blood sugar if needed.



Testosterone gels (Androgel, Testim) can reduce waist size in men, but only by lowering subcutaneous fat. In studies, no visceral fat decreases were seen. Testosterone is usually prescribed for people with HIV who have low blood levels of natural testosterone. Data in women are lacking, but one study of 23 women found that those with HIV-related lipodystrophy had higher testosterone levels than HIV-positive women without lipodystrophy. Gels, injections, and a new subcutaneous pellet delivery system are becoming more commonly accepted by physicians.


Oxandrin (oxandrolone, or Anavar in foreign countries) , an oral anabolic steroid, showed encouraging results for decreasing visceral fat in a small pilot study. But LDL cholesterol increased and HDL cholesterol decreased, along with a small decrease in subcutaneous fat. No body fat studies have been done with the other commonly used anabolic steroid, nandrolone decanoate.


Nutrition studies are lacking. A study at Tufts showed a trend toward less lipodystrophy in those who exercised and increased their soluble fiber (fruits and vegetables). More research is needed on low-carbohydrate diets, which have been shown to improve insulin resistance and visceral fat in HIV-negative people. One observational cohort found that people with HIV eat more saturated fats, which could lead to fat problems. A study of nutrition and lifestyle modifications resulted in decreased belly fat in people with HIV, so there is a clear need for more care providers and organizations to include nutrition and exercise information in their educational efforts.


Sticking to an exercise program can be a challenge for many people who lead busy lives or can't afford to join a gym. But effective home exercise programs are available and could be part of the health counseling given by health care providers and organizations.

Aerobic exercise and weight training decreased triglycerides and visceral fat in a small pilot study. Another study showed that strength training increased lean body mass and decreased fat mass more than aerobic exercise, while improving cholesterol and triglycerides. A regimen of an hour of strength training combined with 20 minutes of aerobic exercise three to four times a week has been shown to work for most people (results take at least eight weeks to be noticeable). But exercise research in HIV remains in its infancy. Sticking to an exercise program can be a challenge for many people who lead busy lives or can't afford to join a gym. But effective home exercise programs are available and could be part of the health counseling given by health care providers and organizations.Liposuction, assisted by ultrasound, seems to be effective at removing fat from the hump that can occur at the back of the neck. Breaking the fat fibers with ultrasound can loosen them up for easier removal. But this can not be used for removing the visceral fat that surrounds organs in the belly, since removing that is too risky. Some insurance plans and Medicare pay for liposuction when the fat gain is associated with pain or sleep disorders.

Fat gain can also occur in the upper part of the body, especially in the breasts. Some studies show increases in estradiol, a female hormone, in men taking Sustiva. This may cause gynecomastia (increased breast size) in a few people. Drugs like Arimidex, an estrogen blocker, or switching from Sustiva can help those who are in early stages of this problem.

Fat burners are being promoted by some TV commercials. But they have not been shown to work and can increase blood pressure and anxiety. Also, beware of nutritional growth hormone supplements -- there are no data indicating that they work.