I could clear any room in moments with the smelly exhaust I was producing,” says Boston PWA David Stafford (not his real name). “And my diarrhea was so frequent, I didn’t want to leave the house.” Many protease takers are experiencing particularly odoriferous gas, often accompanied by bloating and diarrhea. The reasons aren’t clear, but one theory is that protease inhibitors hinder the body’s processing of fats. This is on top of digestive problems already present in many HIV positive people, including small-intestine dysfunction and fat malabsorption.

Dennis Rosa-Re, MD, director of clinical research at the Ryan White Foundation for Medical Treatment in Fort Lauderdale, Florida, has a simple solution that he says is successful in more than two-thirds of his patients: Taking enzymes at the beginning of every meal. In particular, Rosa-Re recommends Ultrase MP20, a medically approved product (covered by insurance) that contains several pancreatic enzymes needed for digestion, including a high amount (20,000 international units, or IUs) of lipase, a fat-digester. He has found that about 80 percent of his patients with protease-induced diarrhea and gas have a high fat content in their stools, a clear indicator of fat malabsorption.

“Flatulence is a sign of digestive disturbance,” Rosa-Re says. “After we do a GI [gastrointestinal] workup [battery of tests] to rule out other possible causes, we recommend the enzymes.” He urges taking the enzymes every time you eat—even with snacks. This prevents the passage of undigested food into the lower intestine where, when worked on by bacteria, smelly gas and diarrhea can be produced. He recommends one enzyme tablet before eating light, and two before a heavy meal. Smaller, more frequent meals can also help ease digestion.

In Rosa-Re’s patients, this approach often results in dramatic reductions in gas and bloating, along with far fewer bowel movements and firmer stools—a good indicator that the body is absorbing both drugs and nutrients better. It may also help PWAs break a vicious circle: HIV-related nutrient deficiencies lead to inadequate production of pancreatic enzymes, which worsens nutrient deficiencies, which decreases enzyme production and heightens digestive dysfunction.

If you can’t get your enzymes prescribed, try a health-food store or PWA buyers club. When choosing a product, keep in mind that many different enzymes are needed for good digestion: Not only lipase for fat, but also protease for protein, lactase for lactose (the principal milk sugar in dairy products) and various enzymes, including amylase and glucosidase, for carbohydrates. (Note: Not all enzyme-combo formulas sold include lipase.)

Stafford is one happy camper. “The combination of taking enzymes with every meal and some glutamine for my small-intestine health [see “Power Nutrients,” POZ, July 1998] let me get out of the house again. And it’s made me socially acceptable,” he says. “My grateful husband will definitely never let me run out of the enzymes.”


When you want to go down, dam it! Call the Glyde Dam Lollyes hotline at 206.283.7664 or e-mail glydeusa@ aol.com for some scented Sheer Glyde Dams.

We can’t vouch for the food, but honey, the decor is a pill. Next time you’re in swingin’ London, visit Pharmacy at 150 Notting Hill Gate.

“Takin’ It to the Streets”
Are you a Ruby wannabe? To learn more about From Our Streets with Dignity (FROST’D), an organization whose mission is “working to prevent HIV infection among New York City’s sex workers,” call 212.924.733, or drop them a line at 369 Eighth Avenue, New York, NY 10001.

“It’s All About the Journal”
Write on! For information on Intensive Journal Workshops offered nationwide, contact Dialogue House at 800.221.5844, or cybersurf over to their site: www.intensivejournal.com. (Bargain tip: Ask about special group rates for PWAs.)

“Stink Balms”
Having trouble down below with the gas problems discussed above? Digestive enzymes can be obtained from two nonprofit buyers clubs. Call DAAIR at 888.951.5433, or check out some background information on their website by clicking to www.immunet.org/daair. The Houston Buyer’s Club can also help you out at 713.520.6630.