Nutrition and HIV/AIDS

If you're HIV-positive, nutrition and HIV is a subject you'll want to pay special attention to. That's because your body will undergo changes, both from medications and the disease itself. For example, you may experience extreme weight loss, infections, or diarrhea. Another common change is lipodystrophy (fat distribution syndrome) which can cause body shape changes and increases in cholesterol levels. Making improvements in your diet can improve your health and how well you feel. Here are a few tips that may help. A registered dietitian (RD) can give you even more guidance.

Why Nutrition and HIV/AIDS Are Linked

If you are HIV-positive, good nutrition can have several benefits. It can:

• Improve your overall quality of life by providing nutrients your body needs.
• Keep your immune system stronger so you can better fight disease.
• Help manage HIV symptoms and complications.
• Process medications and help manage their side effects.

The Basic Principles of Nutrition and HIV

The basic principles of healthy eating will also serve you well if you are HIV- positive. These principles include:

• Eating a diet high in vegetables, fruits, whole grains, and legumes
• Choosing lean, low-fat sources of protein
• Limiting sweets, soft drinks, and foods with added sugar
• Including proteins, carbohydrates, and a little good fat in all meals and snacks

Here is more specific information to get you started with a healthier eating plan.

Calories are the energy in foods that provide your body with fuel. To maintain your lean body mass, you may need to increase calories. To get enough calories:

• Consume 17 calories per pound of your body weight if you've been maintaining your weight.
• Consume 20 calories per pound if you have an opportunistic infection.
• Consume 25 calories per pound if you are losing weight.

Protein helps build muscles, organs, and a strong immune system. To get enough of the right types of protein:

• Aim for 100-150 grams a day, if you are an HIV-positive man.
• Aim for 80-100 grams a day, if you are an HIV-positive woman.
• If you have kidney disease, don't get more than 15%-20% of your calories from protein; too much can put stress on your kidneys.
• Choose extra-lean pork or beef, skinless chicken breast, fish, and low- fat dairy products.
• To get extra protein, spread nut butter on fruit, vegetables, or toast; add cheese to sauces, soups, potatoes, or steamed vegetables; add canned tuna to salads or casseroles.

Carbohydrates give you energy. To get enough of the right types of carbohydrates:

• Eat five to six servings (about 3 cups) of fruits and vegetables each day.
• Choose produce with a variety of colors to get the widest range of nutrients.
• Choose legumes and whole grains, such as brown rice and quinoa. If you do not have a gluten sensitivity whole-wheat flour, oats, and barley may be ok. If you do, stick with brown rice, quinoa, and potato as your starch sources. If you are diabetic or pre-diabetic or have insulin resistance, then most of your carbohydrates should come from vegetables.
• Limit simple sugars, such as candy, cake, cookies, or ice cream.

Fat provides extra energy. To get enough of the right kinds of fat:

• Get 30% of your daily calories from fat.
• Get 10% or more of your daily calories from monounsaturated fats.Examples: nuts, seeds, avocado, fish, and canola and olive oils
• Get less than 10% of your daily calories from polyunsaturated fats.Examples: fish, walnuts, flaxseed, and corn, sunflower, soybean, and safflower oil
• Get less than 7% of your daily calories from saturated fats.Examples: fatty meat, poultry with skin, butter, whole-milk dairy foods, and coconut and palm oils.

Vitamins and minerals regulate your body's processes. People who are HIV- positive need extra vitamins and minerals to help repair and heal damaged cells. Eat foods high in these vitamins and minerals, which can help boost your immune system:

• Vitamin A and beta-carotene: dark green, yellow, orange, or red vegetables and fruit; liver; whole eggs; milk
• B vitamins: meat, fish, chicken, grains, nuts, white beans, avocados, broccoli, and green leafy vegetables
• Vitamin C: citrus fruits
• Vitamin E: green leafy vegetables, peanuts, and vegetable oils
• Selenium: whole grains, nuts, poultry, fish, eggs, and peanut butter
• Zinc: meat, poultry, fish, beans, peanuts, and milk and other dairy products

Because it is difficult to get enough of all the nutrients you need from foods, your health care provider may recommend a multivitamin/mineral tablet (without extra iron). Check the label to make sure it provides 100% of the recommended daily allowance (RDA). Discuss with your doctor what you're taking -- more is not always better. If you don't eat at least three servings of high-calcium (green leafy veggies or dairy) foods each day, you might need to add a calcium supplement to your diet. This is becoming controversial however and more research is being done on this topic.

Nutrition and HIV: Coping with Special Problems

Your body may have a variety of responses to HIV and you may also experience side effects from medications. Here are tips for dealing with some of the most common problems.

Nausea and vomiting

• Try bland, low-fat foods, such as plain pasta, canned fruit, or plain broth
• Eat smaller meals every one to two hours.
• Avoid greasy or spicy foods, or foods with strong odors.
• Drink ginger tea or ginger ale.
• Eat more cold foods and fewer hot foods.
• Rest between meals, but don't lie flat.
• Ask your doctor about nausea medications.

Diarrhea

• Drink more fluids than usual. Try diluted juices or Gatorade.
• Limit milk and sugary or caffeinated drinks.
• Eat slowly and more frequently.
• Avoid greasy foods.
• Try the B.R.A.T. diet (bananas, rice, applesauce, and toast) for a brief time.
• Instead of fresh produce, try well-cooked vegetables or canned ones.
• Try calcium carbonate supplements or fiber supplements like Metamucil wafers.

Lack of appetite

• Exercise to help stimulate your appetite.
• Don't drink too much right before meals.
• Eat with family or friends, making meals as attractive as possible.
• Try smaller, more frequent meals.
• Include a variety of textures, shapes, and colors.
• Ask your doctor about medications that stimulate appetite.

Too much weight loss

• Include more protein, carbohydrates, and fats in your diet.
• Use cream or half and half on cereals. Add ice cream to desserts.
• Eat dried fruits or nuts for snacks.
• Talk to your doctor about adding a nutrition supplement, such as Boost, Ensure, or Carnation Instant Breakfast.
• Ask your doctor about medications that stimulate appetite and treat nausea.

Mouth and swallowing problems

• Eat soft foods such as yogurt or mashed potatoes.
• Avoid raw vegetables; cook them instead.
• Choose softer fruits, such as bananas or pears.
• Stay away from acidic foods, such as oranges, lemons, and tomatoes.
• See your doctor to make sure you do not have an opportunistic infection or need more diagnostic testing.

Lipodystrophy (fat redistribution syndrome)

• Limit fat, especially saturated and trans fats.
• Choose unsaturated fats and sources of omega-3 fatty acids, such as salmon and tuna.
• Limit alcohol, and refined sugars.
• Prevent insulin resistance by limiting foods that raise glucose and insulin levels: primarily carbohydrates.
• Eat more fiber-rich whole grains, fruits, and vegetables.
• Exercise.

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