Eat well and eat more. That’s the simplest food rule for those seeking to reverse—or, better, prevent—wasting. For many, that means first boosting appetite and then cranking up calorie intake. Harvard dietitian Charles Smigelski, RD, says, “You need to consume 16 to 18 calories per pound of body weight daily if you’re asymptomatic, 19 to 20 when ill or losing weight.” So pack three meals in, along with healthful snacks. And be smart about your food choices.

As crucial as calorie boosting is, warns Toronto food chemist and HIV nutrition expert Chester Myers, PhD, “too much fat can cause diarrhea in those with malabsorption. The exceptions are sources of medium chain triglycerides [MCTs]—found in coconut fat and MCT oil—which boost fat calories without causing problems.” Myers also notes that high-sugar intake is a no-no. “It’s immunosuppressive and thrush promoting,” he says. “Get your extra calories from healthier sources.” And those with lactose intolerance should avoid dairy products or drinks containing lactose, which can provoke diarrhea.

Blended or canned drinks, warm soups and other snacks—and the appetite boosters that make you want to consume them—can all contribute to netting those needed calories. But beware that increasing food intake tends to increase fat more than the muscle also needed for protection from wasting. So chow down, but combine it with other parts of a comprehensive anti-wasting program (see “Fat Chance”).

BLENDED DRINKS
These can be more nutritious than canned drinks. A Myers blender recipe: rice milk (such as Rice Dream) or regular milk (if there’s no lactose intolerance) combined with half a banana, half an apple and a tablespoon or more of Knudsen Coconut/Pineapple Nectar for the MCTs and, of course, the piña colada taste. Pack more calories with a tablespoon or two of coconut oil or MCT oil (available in Asian- or whole-foods stores). Add other fruits (fresh or frozen) and vanilla or other flavorings as desired. If you prefer it smoothie style, add ice before blending. If your diet is short on protein, add high-quality protein powder. Among the best: Twin Labs’ Twin Pro (free amino acids) and whey protein products (which also provide immune-supporting glutathione) such as Next Nutrition’s Ultimate Whey Designer Protein, Optim Nutrition’s Optimune and Solgar’s Whey-to-Go. Another good (but pricey) whey product, Immunotec’s Immunocal, is covered by Medicaid when prescribed for wasting.

CANNED DRINKS
Choose brands that are:

high in carbohydrates and calories
moderately high in quality protein, preferably from partially hydrolyzed lactalbumin, partially hydrolyzed whey protein (but only if lactose-free) or high-quality rice protein
low in fat (or high in MCTs)
low in sugar, preferably with a dextrose or fructose equivalent (DE value, which means the proportion of sugar) below 30.


Chester Myers recommends Clintec Peptamen, Clintec Nutren 2.0, Ross Labs’ Advera, Mead Johnson’s Lipisorb (especially useful for those with fat malabsorption) and IsoCal. Because of their fat and/or sugar content, Myers strongly advises against Sustacal, Resource, Ensure, Boost and Enercal. Reimbursement for canned drinks, often very expensive, varies by state; ask your doc or dietitian for info.

SOUPS AND SNACKS
Warm soups are easy to consume, require less energy to digest and may stimulate appetite. If appetite is really low, puree the soup in a blender or food processor to make a thick, creamy broth. You can create easy-to-eat but nutrient-rich meals by making your own soups with fresh ingredients, including fresh vegetables (for vitamins and minerals); brown rice, lentils, beans or whole-grain noodles or macaroni (for protein and calories); and turkey, chicken or fish (for protein plus). Save labor by cooking a large batch and freezing the leftover. For an extra calorie boost, down a cup of soup between meals along with other snacks: whole grain pretzels; tuna or hard-boiled eggs with crackers; low-fat, fruit-juice-sweetend granola or other whole-grain cereals.

APPETITE BOOSTERS
Appetite boosters and nausea fighters that help many PWAs include Marinol (the synthetic marijuana-type drug) and its herbal counterpart. The drug Megace (megestrol) also increases appetite but can further suppress testosterone, so if you use it, keep an eye on your hormone levels. A catch-22: Malnutrition itself can cause appetite loss; the only solution is eating regularly even when you don’t feel hungry. Supplementing zinc (50 to 75 milligrams daily) may also help, since deficiency of this mineral (common in PWAs) can cause loss of smell or taste sensations.