A Good Cook: Nutrition for People With AIDS
Daisy Fried ". . .when you started craving deli/ I heaved a sigh because salami was so de-/ germed with its lovely nitrites to hell with/cholesterol that's for people way way over/ the hill or up the hill not us in the vale/ of borrowed time. . ./ . . .cramming you with zinc and Haagen-Dazs so wild/ to fatten you up I couldn't keep track of/ what was medicine what old wives. . ." -- Paul Monette's "The Worrying"That poem -- one of 18 Monette published in 1988 about his AIDS-stricken lover -- blinked up in my brain while I was paging through Robert H. Lehmann's new book "Cooking For Life: A Guide To Nutrition and Food Safety For the HIV-Positive Community."Lehmann, 44, of Center City, knows pretty clearly what's medicine, what's old wives and what, critically, is nutrition. The former executive chef for the Metropolitan AIDS Neighborhood Nutrition Alliance (MANNA), he is well-versed in the sort of knowledge that's helping people with AIDS survive longer.Published this month by Dell (paper, $10.95), "Cooking For Life" has been endorsed by people like Donald Kotler, M.D., the pioneer of AIDS nutrition, and Mathilde Krim, founding co-chair and chairman of the board of AmFAR, the American Foundation for AIDS Research.Kiyoshi Kuromiya, the director of the Philly-based Critical Path Project, the cutting-edge clearinghouse for AIDS treatment information, also praises the book. A former food writer himself, Kuromiya says it's "what we people with AIDS have been waiting for: a pocket book for devotees of good food and good health incorporating eminently practical tips for HIV nutrition."And though the book is specifically written for people with AIDS -- Lehmann thought about addressing cancer-sufferers as well but decided he didn't know enough about their specific problems -- it also contains plenty of eye-opening information for everyone, regardless of their state of health. How to clean a cutting board. The dangers of electric can openers. Just how good various special diets are. Plus several dozen high protein recipes, from egg drop soup to meat loaf to a lactose-free "milk" shake.As MANNA's first chef, Lehmann worked in the vanguard of an organization that is now well-known for delivering meals to homebound Philadelphians with AIDS. He currently coordinates the HIV Nutrition Research program at Graduate Hospital, which is compiling information on a variety of AIDS nutrition issues. In a concurrent life, Lehmann teaches fashion design and costuming at Philadelphia College of Textiles and Science.To his interview at the cafe La Colombe, he wears jeans, sneakers, a South American print shirt, a beard that's just beyond stubble, and what looks to me like one of the kindest, pleasantest, sincerest smiles in the city of Philadelphia.Amazingly, his is the first book about AIDS nutrition and food safety to go beyond info-pamphlet superficiality, without becoming impossibly technical. "There are medical tomes," says Lehmann. "But I can hardly understand them."Lehmann, 44, came to Philadelphia seven years ago from Durham, NC. In Durham, besides working in restaurants and running a catering business, he worked as a hospice volunteer and as an AIDS buddy. After buddying a man with AIDS whose lover beat him up, stole his Social Security check and locked him out, "with classic naive zeal I went to the Lesbian and Gay Health Project [in Durham] and talked to the director about what I could do," Lehmann says."She said that 'as bad as that is, there are people living out of cars.' At that time people working in the AIDS community were up to their eyeballs, there was so much that needed doing. They spent all their time putting out forest fires. But she said if I wanted to try to do something I had her blessing."Lehmann was eventually able to found Durham's AIDS Community Residence Association with funds that corporations and funders were just beginning to spend on AIDS causes. The shelter still exists.When he came north to Philly - "life wasn't clicking for me; I moved here to jump-start my life" - he continued working in the restaurant business. MANNA had just started up. At first it paired clients with restaurants willing to donate meals. Lehmann coordinated the donated meals at the restaurant where he worked, and then, when MANNA decided to hire a chef to make meals, Lehmann got the job."When I was first interviewed, nothing was asked or even mentioned concerning my knowledge of nutrition, and it was a good thing; though I had been cooking one way or another for more than 25 years, I had never paid more than cursory attention to nutrition," he writes.But people would call MANNA for nutrition information, and the questions would be passed to him. "I guess they figured, 'He must know, he's the chef.'"Lehmann began to call upon a trio of sources - Dr. Norma Muurahainen and nutritionists Peggi Guenter at Graduate Hospital and Margaret Cauterucci at Southeast Health Center - who'd answer his questions. Gradually he built up his knowledge."It's funny, when MANNA opened, everyone assumed we'd open the doors and people would come and we'd have a hard time keeping them back. But we had to do a lot of outreach and keep calling back case managers. Now it has a high enough profile, but for the first several years it was a remarkable struggle to get the number of clients over 100. I mean this is a big city and a lot of people have AIDS, and our only criteria for the program was that you have AIDS and be homebound. But it's a larger organization now."At first Lehmann was able to do special-diet meals for people with special medical problems - nausea, or mouth sores, or lactose intolerance. Eventually, the program grew to the point that there was too much work for the couple of paid staffers and their volunteers to produce special meals. So for a while everyone got the same meals based on the general principles that Lehmann would later outline in "Cooking For Life."In 1992, Lehmann was awarded both the "Humanitarian of the Year" and the "Distinguished Service by an Individual" awards by the "Philadelphia Gay News" readers poll.He began teaching a "Cooking For Life" class for people with AIDS in 1993 - and the course received such a good response that he wondered why no user-friendly but thorough book had been written on the subject. He kicked around the idea of doing it himself, but didn't know how to get started.In 1994 he was fired. Lehmann says the director decided "I was too difficult to work with. I got standing ovations at volunteer meetings and would go to meetings and report that I had gotten food costs down and done extra things like inventing the cooking classes, while everyone else at the meetings would have an excuse why they had not met their goals. So yes, I was quite testy, since I felt I was doing twice my job and everyone else was doing half their job. And the director just felt I was too difficult to work with."By now things are mended with MANNA. The director who fired Lehmann left six months later, and the organization is sponsoring Lehmann's Feb. 20 book-signing at Giovanni's Room.Lehmann's other life, the fashion design life, started at North Carlina's Guilford College, when he was acting in plays. Though he didn't know the difference between a needle and a pin at the time, he offered to help a costume designer who was swamped, saying, "If you show me, I'd be happy to help out."He picked it up quickly, liked it, and transferred to the North Carolina School of the Performing Arts (where one of his ballet-dancer classmates would later become the cowboy in the Village People). But the school's costume department was weak, so he transferred again, this time to the Fashion Institute of Technology, after which he got a job as assistant to Diana Vreeland at Metropolitan Museum of Art's Costume Institute. Among the shows he worked on was the Met's "Romantic and Glamorous Hollywood Design" exhibition. Some of the costumes from the movies no longer existed, and designers like Bill Blass, Ralph Lauren and Donna Karan were called in to reproduce costumes."And even though I was 21, green as grass, just out of North Carolina, I was one of the 14 people who recreated costumes," he says.His contribution to the show: a copy of the ostrich feather dress Ginger Rogers wore in the "Cheek to Cheek" scene in "Top Hat."He moved on into costuming for theater, but after a few years decided it wasn't what he wanted to do. He moved back down south and went into restauranting, as a waiter and later as a chef."I never expected to be involved in fashion again, but things happen to me in cities," he says.A few years ago, a friend of a friend who worked at Textile told Lehmann a professor there was leaving mid-semester, and asked if Lehmann could fill in. He agreed. And then he stayed on. And just last year he became costumer for Savoy Company, Philly's Gilbert and Sullivan ensemble."I actually spend a lot more time on the AIDS stuff," he says. "I have a limited attention span, so I need to have a couple of irons in the fire."And here's how "Cooking For Life" finally got written:"In January of 1994, a friend of mine in Florida called me up and asked what I was doing after I finished the spring semester. I said I had no plan. He said, 'You're coming down here to write a book proposal.' I said, 'Oh sure,' never dreaming I'd really do it. On June 2, he called to say, 'I'll be there in two days to pick you up.' So I was trapped. I went down to Umatilla, FL, the fern and lighting capital of the world. You know those $5 ferns you get in the supermarket? They're from Umatilla. And it's an hour north of Orlando in the middle of the peninsula. So you're in the middle between the cold Atlantic and the warm Gulf, and meanwhile you're just below this enormous land mass, so every single day that summer there was an enormous electrical storm."Out of the storm came the proposal, and out of the proposal came this extremely calm and pragmatic book.---The media has lately overflowed with reports about protease inhibitors, that magic bullet which seems to have done wonders in restoring the health of people with AIDS. But, besides the fact that they are incredibly expensive and don't work for everyone, it's too soon to know how long the magic will last. Lehmann says many in the AIDS community are worried that the popular press will communicate the idea that AIDS is over, that funding and support for research will drop.Nutrition is less controversial and just as important, Lehmann says. Unfortunately, most doctors know zilch about nutrition."Until recently there was not a single medical school that required a course in nutrition," Lehmann says. "I tell people if they read the back of the cereal box they may know more than their doctor about nutrition. For example: if you have chronic diarrhea it exhausts you because it flushes electrolytes from your system. You get dehydrated. MANNA had a client who called and asked if there was anything he could do for his diarrhea. We told him to drink Gatorade. He called back two days later and said he hadn't been out of the house for two months but now, for the last two days, he'd hardly been "in". It was that simple, and no doctor had told him."Nutrition isn't a cure, Lehmann says, but eating well and safely are key to long-term survival. Studies show long-term AIDS survivors share five characteristics: commitment to living, active participation in one's own well-being, flexibility, long-term goals, and networking with other people with AIDS.Good nutrition, Lehmann says, is part of the first three of those. "When a perfectly healthy person loses a third of his lean body mass [muscle, skin, organs - anything that's not fat or bone] death occurs. You have no defenses - a cold can do you in. Wasting is the second most common AIDS-defining illness in America."Among a variety of causes for wasting: depression, parasitic infection, mouth or throat soreness, reduced ability to absorb nutrients, lack of money to afford food.Lehmann draws a zigzag line of descending stairsteps with his finger on the wall to show the progression of AIDS."A person with AIDS who has repeated bouts of PCP [AIDS pneumonia] can survive the infection with medication, but if they are losing lean body mass, each infection is worse. Each time they recover with greater difficulty, as their weight drops. The fifth time maybe they die. You can extrapolate from that to say most deaths from AIDS are from starvation."With that in mind, the usual nutritional food pyramid - lots of carbohydrates, fruits and veggies next, then milk and meat, then just a little fat, oil and sweets - is reversed. More protein means more body mass to go through before the body's depleted, so protein intake is most important. Next, fruits and vegetables provide nutrients necessary to metabolic (including immune) functioning."Grains and starches are important but are filling," writes Lehmann. "[They] may prevent the intake of more nutritionally valuable foods."Fats and oils help with weight gain. "With AIDS," says Lehmann, "chubby is good."The other half of the nutritional balancing act is keeping food safe, since people with weak immune systems are more likely to get food poisoning because their bodies have a much harder time getting rid of the poison. The book discusses food safety and water filtration and talks about how diet can ease AIDS-ailments like nausea and diarrhea.Here are a few bits from "Cooking For Life" which caught my attention:-On eating out: Most restaurants Lehmann has worked in have been clean. But, he writes, "I once worked, briefly, in a restaurant of national reputation where. . . untrained and unskilled kitchen workers would stand in the sweltering heat cutting up raw chicken. . . If someone from the salad station. . . needed more cucumber sliced quickly, the mound of warm, raw chicken would be pushed to the side of the table and, with no further preliminaries, cucumbers would be cut. From one day to the next these tables would be given only the barest wipe-down. . . To this day you can buy this restaurant's cookbook in many bookstores throughout the country."-On preventing traveler's diarrhea: ". . .eat a locally produced fermented dairy product, such as yogurt, which is made from pasteurized milk. This will help acclimate your system to strains of local 'friendly flora' or 'good' bacteria upon which it depends as part of the digestive process. The regional variations of useful bacteria, while not toxic, may be enough to wreak havoc with your gastrointestinal tract until they are assimilated by your body. By introducing them to your system in this manner, much simple traveler's diarrhea may be avoided."-On veganism: "Most nutrients in plants. . . exist in a form that is very difficult or impossible for our bodies to use if not accompanied by other nutrients. . . found in animal-source food. For example, spinach is an excellent source of iron but presents it in a form largely unassimilable to someone who is a vegan. . . a truckload of spinach would have to be consumed "daily" to assure adequacy if this were your only source of iron. But with the concurrent intake of meat, the iron in spinach is accessible. . ."-On macrobiotics: ". . .you could hardly design a worse diet. . . for a person in any advanced stage of HIV disease. . . a macrobiotic diet is precariously low in protein. . . extremely high in insoluble fiber, which can ravage an already delicate digestive tract. . . and it is a very demanding discipline. . . hardly the expenditure of energy a sick person is apt to be willing or able to keep up with."Finally, Lehmann advocates another use of nutrition with regard to AIDS. If a patient is terminally ill and wants to die, he can stop eating and drinking."If you drink water but stop eating it's very painful, but if you stop both at once it tends to be painless," Lehmann says. "You get groggy and that reduces your anxiety. You know, the group Final Exit tells you what combination of pills to take, and to put a plastic bag over your head. I don't know, I wouldn't want to die with a plastic bag over my head. And I have vast admiration for Kevorkian, but I wouldn't want to die hooked up to a Volkswagen. Animals simply stop eating and drinking when it's time to die."Lehmann, who is HIV-negative and gets tested regularly, decided not to get tested again till his book was finished."It can really send you -" He makes a spiraling motion with his hand like something spinning out of control. "From what I've seen, it takes about a year after your diagnosis to get on with things."He pauses."I really "don't" want you to think I'm a relentless do-gooder. I think I'm more like Kathleen Turner in "Serial Mom"," he says, with a decidedly un-Kathleen Turnerish beam.