HIV Wasting Syndrome

Published in Micronutrient Supplementation for Patients with HIV, written by Dr. Michael Todd Greene, Ed.D., M.S.,  R.D.N., September 2009.

(Part of course “Severe Malnutrition” available on this website.)

Cachexia affects over 5 million people in the U.S. It is the major cause of excessive weight loss in the setting of ongoing disease. Symptoms include a disproportionate loss of muscle mass. Some advanced disease states include cardiac cachexia, chronic renal failure, chronic obstructive pulmonary disease, anorexia-cachexia syndrome in cancer, rheumatoid arthritis and cachexia, aging and weight loss, and AIDS-related cachexia (wasting syndrome) (Morley, Thomas and Wilson, 2006).

The major cause of cachexia is cytokine excess. Cytokines produce the following etiology of anrexia, weight loss, cognitive dysfunction, anemia and frailty. Cytokines are cell-associated protiens produced as an inflammatory immune response. To combat the effects on the body, there are three areas recommended, nutritional support, orexigenic agents (hormonal therapy) (Morley et al., 2006), and physical exercise (Wolfe, 2006).

Elaboration of pro-inflammatory cytokines may be the major factor responsible for AIDS wasting. Cachexia associated with AIDS is highly predictive of death. AIDS wasting includes anorexia, depression, medications, coexisting infections and a variety of gastrointestinal diseases (Morley et al, 2006).

The question arises, how does someone exercise when having fever, diarrhea and no appetite? Can an exercise pill help increase muscle without physical work?

The benefits of physical exercise on general health make the identification of an orally active agent that mimics the potential effects of exercise on metabolic diseases worth studying. Certain micronutrients like Resveratrol. have endurance-enhancing affects but the exact metabolic targets are still not know. Testing the effect of pathway specific drugs on endurance of mice in a treadmill test was documented in August 2008 (Narkar et al., 2008). This study found that AICAR (AICAR 5-aminoimidazole-4-carbonoxyamide ribonucleoside) is a drug found to help change the physical composition of muscle transforming tissue from sugar-burning fast twitch fibers to fat-burning slow-twitch ones. Essentially producing the benefits of aerobic activity without the work in mice. AICAR has been found to be safe (Zarembo, 2008).

Next must read blog: Proposed clinical trial: HIV Wasting Syndrome.

Morley, J., Thomas, D. & Wilson, M. (2006) Cachexia: pathophysiology and clinical relevance. The American Journal of Clinical Nutrition, 83(4), 735-743.

Narkar, V., Downes, M., Yu, R., Embler. E., Wang, Y. Banayo, E., et al. (2008). AMPK and PPARo Agonists Are Exercise Mimetics. Cell, 134(8), 405-415.

Wolfe, R. (2006). The underappreciated role of muscle in health and disease. The American Journal of Clinical Nutrition, 475-82.

Zarembo, A. (2008, August 1). AICAR: Scientists say they’ve put exercise in a pill. Los Angeles Times.


e-Consult MNT (Workgroup)

e-Consult Toolkit
DocRD™ is a Workgroup Member

e-Consult MNT (Medical Nutrition Therapy) by DocRD

Adapted from e-Consult Toolkit website for DocRD is on Workgroup

Access to specialty care continues to be a major challenge for low-income and underserved of our population. In California and with provider shortages and long wait times for appointments, demand continues to outpace the health care system’s ability to meet the needs of California’s growing low-income patient population.

To address this challenge, many health care professionals, health centers, systems, payers and policy makers are turning to electronic consultation and (with a physician referral as example), or e-Consult.

What is e-Consult?

From the workgroup website: An e-consult, is an asynchronous dialogue initiated by a physician or other qualified health care professional seeking a specialist consultant’s expert opinion without a face-to-face patient encounter with the consultant.

What should I expect from my practitioner?

Adapted from the workgroup website: The specialist will report identified as an  inter-professional consultation. E-consults provided by consultative physicians (or health care professional) should include written reports to the patient’s treating/requesting physician/qualified health care professional.

Personal Wellness How and Why

We make a commitment to ourselves and we make a commitment to everyone around us.

Personal Wellness: take a look at this article which will get your willingness to have personal wellness.

Personal Wellness

Make a commitment to improve on your personal wellness.

How to create a personal wellness plan.

Continue the commitment with a personal wellness plan.

Editorial Board: My Accomplishments


An open source international journal publication asked me to provide some information about my work. This comes at a time when I am on various Editorial Boards for scientific journals.

My Accomplishments

Dr. Michael Todd Greene, Ed.D., M.S., R.D.N.

Doctor of Education Registered Dietitian Nutritionist

Editorial Board of Recent Advancement in Food Science and Nutrition Research (ISSN 2638-9770)
a Open Source International Journal

Nutritional Science

Preceptor Coordinated Dietetic Program


Professional Baking

Baking Science and Technology

Large Scale Baking Assembly Line Management

Food Service Director

General Manager

Food Services Coordinator of all food operations

Startup opening of a standalone Starbucks café

Severe Malnutrition

Food Insecurity

Quality in hospitals

Reducing Hospital Admissions

Contracted with suppliers to budget for improved bottom line

Drill Down to discover

Graduation Speaker at Los Angeles Trade-Technical College

Life Changing, Leadership and Effective Management

Severe Malnutrition

Subject matter expert

Food Safety

Front Line Labor

Technical Trainings

Team with subordinate managers

Look up to but remain humble idol comraderies with co-workers

Outpatient Consultations

Outpatient Coaching

Physician matters and support

RD’s writing orders for Physicians to sign

Changed Nursing Initial Patient Screening, i.e., Nutritional Screening.

Implemented New Electronic Medical Record System

Paper Charting

Investigative savvy

Took on the administration of 401(k)

Investing proneness

RD Doctor of Education,Educational Psychology, Educational Leadership

  1. Gap: Motivation to Change One’s Health Behaviors
  2. Curriculum Development
  3. Online learning
  4. Scholarly Research Evidence Based, empirical, published, poster, presentation, peer review community
  5. Focus on low income, underprivileged, underrepresented populations of our society.
    1. LA Job Corps.
    2. Job Corps, Federal
    3. Secretary of Labor and the Labor Act
    4. Looked to use of technology today and made the most impact with research instruments
    5. Statistics and Quantitative vs. Trends, Observations and Motivation studies
    6. Food Insecurity
    7. Worked with Government agencies, i.e. Dept. of Public Social Services, Consulate General’s, LA County Community provided resources, i.e., LA Food Bank,
    8. Logic studies
    9. Network for a Healthy California
    10. Presented to District wide (Road Tour) to School Nurses of LA Unified to look for signs of food insecurity and what can be done by you, a School Nurse.
    11. Kaiser Permanente, Westside and Inglewood Group Teaching
      1. Different audiences, i.e., school children, siblings and parents of family
      2. Individual Consultations as Physician Referrals

Service Provider

Initial DocRD™ Nutritional Consultation powered by DocRD™
Individual Medical Nutrition Therapy with nutrition coach DocRD™

This is what you need to know. Your first step to achieving your nutritional goals.

Medical Nutrition Therapy

About Your Nutrition?

Severe malnutrition is no laughing matter. You’ve talked to your family about their nutrition. Now you need to act but what to do? Answer is speak to a nutrition expert, speak to DocRD™ Doctor Registered Dietitian.

What Next: before your DocRD® Nutritional Consult

DocRD® Nutritional Consultation | DocRD® e-Consult MNT
What next?


Schedule your appointment in 2 weeks:
Prepare for your appointment by:

  1. 1. Obtaining your lab report(s): By filling out this medical authorization form you are authorizing your Doctor’s office to give you recent lab report(s).
  2. 2. Do a 3-Day Dietary Recall: List everything you eat or drink and the amounts for three (3) days An example: Lunch (date) Turkey Sandwich, 2 pieces of whole grain wheat bread, 1 oz of sliced turkey, teaspoon of mayonnaise, 2 slices tomato, a lettuce leaf, salt and pepper and 1 cup of water. (Does not have to be consecutive days.) If you don’t complete all three days, then bring what you can.
On your appointment day bring both items with you. Be truthful and enjoy it.

I look forward to our session and for you to begin your journey to have your nutritional goals met DocRD®.

DocRD® Nutritional Consultation | DocRD® e-Consult MNT


What About Acute Malnutrition?

The State of Acute Malnutrition Website is supported by the No Wasted Lives Coalition, an interagency effort between UNICEF, Action Against Hunger, the Children’s Investment Fund Foundation, the European Commission Directorate-General for Humanitarian Aid and Civil Protection (ECHO), the UK Department for International Development (DFID), and World Food Programme (WFP).
To achieve this, the group developed the No Wasted Lives Agenda, a three-point plan seeking to:

  • Make severe acute malnutrition a political and public health priority
  • Discover and disseminate learning about a range of more effective ways to prevent and treat severe acute malnutrition
  • Mobilize more money and maximize effectiveness of current spending
    For more information on No Wasted Lives, please visit

About the Data

In bringing this information together for the first time we aim to:
improve the quality of services,
identify gaps,
and most importantly, enable people to understand the current burden of acute malnutrition as well as treatment coverage at a global and country-specific level.
We understand that improving quality is an iterative process, so contribute to the ongoing quality improvements and discussions on gaps, please submit questions here.

This site brings together information from a range of sources, providing the most up-to-date information on acute malnutrition. Sources include:

UNICEFs ‘Global SAM Management Update Tool (Nutridash)’ data,
Coverage Monitoring Network,
The CMAM Forum,
WHO/UNICEF/World Bank Joint Estimates,
Global Nutrition Report,
WHO mortality database,
WHO Malaria database,
UNAIDS HIV database as well as Center for Disease Control (CDC) databases.
The website also links with WHO’s Global Database on the Implementation of Nutrition Actions (GINA) and ENNs periodic publications (Field Exchange and Nutrition Exchange). Technical questions are directed to en-net, an established online forum hosted by ENN.

Diabetes, Diet, Keto and American Diabetes Association

What is everyone talking about. The following site is a great place to hear from experts about the Keto (Ketogenic) Diet. And what the Medical Nutrition Therapy about the Keto diet. Diet recommendations for Diabetes and Keto diet.

Diabetes & Ketogenic Diet: Can You Manage Your Diabetes On A Ketogenic Diet?


The Diabetes Council asked Registered Dietitians (RD) and Registered Dietitian Nutritionists (RDN) about the Keto diet and people with Diabetes.

Experts Weigh In On Ketogenic Diet for Diabetes Type 2
By Jasmine Burns

Experts Weigh In On Ketogenic Diet for Diabetes Type 2

DocRD™ as well as other RD’s and RDN’s gave a comprehensive look at Diabetes and Keto Diet.,-ed.d.,-m.s.,-r.d

Michael Todd Greene, Ed.D., M.S., R.D.N. said, “I would not recommend a ketogenic diet for someone with DM unless they also suffered from epilepsy. The diet is primarily recommended for hard to control epilepsy in children. I would consider suggesting the Consistent Carbohydrate Diet that is outlined by organizations like Academy of Nutrition and Dietetics and American Diabetic Association”.

But what does the American Diabetic Association (ADA) say about diets.

The ADA does describe a Meal Plan or Meal Planning and Eating Patterns as important diet information for people with Diabetes on their website:

Eating Patters and Meal Planning:



DocRD™ Doctor Registered Dietitian Nutritionist

Educational Leadership | Educational Psychology | Nutritional Science | Health & Wellness

Director of Nutrition & Food Service | General Manager IV | Hospital Food Service & Operations

Baking Science and Technology | Professional Baking | Food Safety | Large Scale Baking

Subject Matter Expert | Severe Malnutrition | Food Insecurity

Nutritional Consultations | Nutritional Coaching

Physician support | Improved Nursing Nutritional Screening |

RD Competencies | RD’s writing orders for Physician’s signature | RD’s Monitoring Intake & Output

Drill Down Investigative Savvy | Quality | Reducing Admissions

Nutritional Science Preceptor | Coordinated Dietetics Program

Front Line Labor | Technical Trainings