Nutrition & HIV

Nutrition is an important part of your lives, whether or not we have HIV. It doesn't mean that just because you have HIV you needn't bother about it.
The age-old saying, "You are what you eat," makes a lot of sense.

Eating a balanced diet gives you most of the vitamins, minerals, proteins, carbohydrates and fats your body requires. In some cases, eating well manages side effects as well.
In this section, you will find some frequently asked questions about the role nutrition plays in a person with HIV.

Is there any food that can fight HIV?

No. there is no magic food that can do that.

Are there special foods that are better for patients with HIV?

It's hard to recommend due to the needs of each individual and stage in therapy.

So what should I eat?

A balanced diet.

What is a balanced diet?

A balanced diet is one that includes the following:

Proteins- from eggs, cheese, milk, yoghurt, chicken, tofu, fish etc.
These also include vitamins and minerals especially iron and vitamin B12 from meat.

Fats- there are good and bad fats. Good fats come from olive, peanut and vegetable oil. Bad fats are usually found in fatty meats, butter and cream and too much of these can lead to heart disease.

Vitamins & Minerals- a daily intake of fresh foods like lots of fruits and vegetables should be sufficient. As far as possible, don't overcook your vegetable. Try stir-frying or steaming.

Carbohydrates- starchy foods like rice, bread, pasta, cereals, potatoes, yams, noodles and grains.

Remember, these are general guidelines so talk to your doctor and dietician for your specific needs.


Can you tell me the things I should consider when I talk to the doctor and dietician?

Yes, here are a few areas you should let them know:

 

• Body weight.
• Your state of health.
• Your lifestyle – do you exercise, smoke, drink alcohol or take illicit drugs.
• Do you eat at home or out.
• Side effects.
• Your viral load and CD4 cell count.
• The medications you are on now.
• Any infections you have had or have.
• If you are pregnant, let them know.
   

Is it advisable to take vitamin and mineral supplements?

A multivitamin to supplement a good balanced diet is recommended by most doctors. Ask your doctor what's best for you.

Will it help boost my health if I take extra large doses of vitamins and minerals?

No. recent research suggests that large doses can sometimes be harmful, especially with the HIV medications you are taking. Again check with your doctor about the right dosage for you.

Can I take traditional herbal remedies?

It is best to let your doctor know what you are taking so he/she can make sure that it doesn't interfere with the HIV medications you are taking.

How do I avoid food poisoning?

Food poisoning is common among people with low immune systems and it's important that you follow the general guidelines below.

• Cook all meat, fish and chicken until well done.
• Avoid raw foods like Sashimi etc.
• Try not to reheat meat that's been stored in the fridge for more than a day.
• Wash all fruits and vegetables properly.
• Avoid too much canned and preserved food.
• If you're eating out, avoid unhygienic places.
• Boil all water that you use for cooking food and drinking.
• Fix a water filter to your tap (change the filter regularly as filter used for too long carry bacterial).
• Don't take raw or half boiled eggs.



Can I take alcohol?

It's best if you don't. but if you can't stop completely or avoid it, moderation is the key word to remember.

What is moderate intake of alcohol?

2 glasses a day but you must have 2 alcohol free days a week.

What are the risks of drinking alcohol excessively?

It can affect your immune system and may slow down recovery from infection.

Heavy drinking can also damage your liver and has been linked to hepatitis.

People who drink heavily very often neglect their diet and this is something someone with HIV shouldn't do.

Finally, heavy drinking can also lead to missed doses of your HIV medications and vomiting which causes more complications.

Are there any infections where alcohol is not allowed?

If you have hepatitis B or C.

 

Tips on how to eat when you are ill

People with HIV are prone to multitude of infections due to weakened immune system. Here are some tips on what you can eat how to cope when you are ill.

• Have food stocked at home and by your bedside if you are too tired to get out of bed.
• Snacking on small meals rather than having 3 main meals may be easier and less tiring to prepare.
• Have fresh juices without ice.
• Call on friends and family to bring food over.
• Have the numbers of home delivery caterers so you can have meals delivered to you.
• If you have difficulty chewing and swallowing, try liquidizing our food or eating porridge.
• If you have sores or inflammation in the mouth, avoid spicy, acidic, salty or very hot food. Again liquidized food and soups ay be less painful alternative.
• If you don't have an appetite to eat, are experiencing severe loss of weight or pain when swallowing, talk to your doctor immediately.

Healthy and balanced nutrition is important for everyone
 

OUR BODIES NEED FOOD

Food is essential for our bodies to:
• develop, replace and repair cells and tissues;
• produce energy to keep warm, move and work;
• carry out chemical processes such as the digestion of food;
• protect against, resist and fight infection and recover from sickness.

Food is made up of nutrients. Micronutrients such as vitamins and minerals
are needed only in small amounts. Macronutrients such as carbohydrates,
protein and fat are needed in larger amounts. The body cannot function
properly if one or more nutrients are missing. A healthy and balanced diet
provides foods in the right amounts and combinations that are safe and free
from disease and harmful substances.

Prevention is better than cure.

The earlier a person starts to eat a healthy and
balanced diet, the more he or she will stay healthy. Once weight has been lost
it may be difficult to regain it because of tiredness and lack of appetite.
The section below contains some guidelines on healthy and balanced
nutrition. These apply to everyone – whether they are infected with HIV or not.


HEALTHY AND BALANCED NUTRITION

Enjoy a variety of foods
Eating well means eating a variety of foods. No single food contains all the
nutrients that our bodies need, except for breast milk for babies up to the age of six months. Eating a variety of different foods will supply the nutrients that are essential for our bodies. By taking care to choose foods that are in season and locally available, eating can be enjoyable, healthy and affordable.
Eat staple foods with every meal Staple foods should make up the largest part of a meal.

These foods are relatively cheap and supply a good amount of energy and some protein. Staples include cereals (such as rice, maize, millet, sorghum, wheat and barley), starchy roots (such as potatoes, sweet potatoes, cassava and yams) and starchy fruit (such as plantains).

Use fats and oils as well as sugar and sugary foods
Fats, oils and sugar are good sources of energy and can help one gain body
weight, which can be particularly important for those living with HIV/AIDS.
They also add flavour to food, thereby stimulating appetite.

Fats and oils play an important part in a healthy and balanced diet. Even
small amounts can provide lots of energy. Fats and oils include butter, lard,
margarine, cooking oil (vegetable, coconut and palm oil), cream, mayonnaise
and coconut cream. They are also found in avocados, oilseeds (sunflower,
groundnut and sesame), fatty meat and fish, curds and cheese.
Sugars and sugary foods include honey, jam, table sugar, cakes and biscuits.
Although fats and sugars are good sources of energy, they are not rich in
other nutrients. They should therefore be eaten in addition to other foods, not
in place of them.

Drink plenty of clean and safe water
Water is important for life and is necessary every day. A person needs about
eight cups of fluid per day. When it is very hot, while working, sweating or
suffering from diarrhoea, vomiting or fever, a person needs to drink even more
to replace the water that has been lost. If drinking-water is collected from a
protected well or borehole it is important to store it in a clean container. If the
water is from an unprotected well or river the water should be boiled for at
least ten minutes and stored in a clean container (see advice on food hygiene on
p. 29). In addition to drinking clean water, fluid can also come from juices,
soups, vegetables and fruit as well as meals that have gravy or sauces. However,
avoid drinking tea or coffee with a meal, as this can reduce the absorption of
iron from the food.
Alcoholic drinks remove water from the body and should therefore be
consumed only in limited amounts. They can also interfere with the action of
medicines.




Healthy and balanced nutrition for growth, work and play

Eat staple foods with every meal These foods are relatively cheap and supply not only energy and protein but also small amounts of vitamins and minerals. Staples include cereals (such as rice, maize, millet, sorghum, wheat and barley), starchy roots (such as potatoes, sweet potatoes, cassava and yams) and starchy fruit (such as plantains).
Eat legumes if possible every day These foods include beans, peas, lentils, groundnuts (including peanut butter) and soybeans. When eaten with staple foods the quality of protein is increased.
Eat animal and milk products regularly Foods from animals and fish should be eaten as often as you can afford them.
They supply good-quality proteins, vitamins, minerals and extra energy. All
forms of meat, poultry (birds), fish, eggs and dairy products such as milk, sour
milk, buttermilk, yoghurt and cheese should be included. If insects, such as
caterpillars or grasshoppers, are part of your eating patterns, they also provide
good nutrients.

Eat vegetables and fruit every day
These foods are important for a person to grow well and fight infection.
A recommended list is provided below.
Yellow, orange, red or dark green Other vegetables and fruit vegetables and fruit Green leafy vegetables (spinach, pumpkin, Tomatoes, cabbage, oranges,
cassava leaves), green peppers, squash, mandarins, grapefruit, lemons, guavas carrots, yellow peaches, apricots, mangoes, passionfruit, pineapples,
papaya and mangoes mulberries and baobab fruit

• Good sources of vitamin A • Good sources of vitamin C;




Special eating needs for people living with HIV/AIDS

A person who is infected with HIV/AIDS and is not showing signs of illness
does not need a specific “HIV-diet”. However, those infected with HIV should
make every effort to adopt healthy and balanced nutrition patterns (as
explained in Chapter three) in order to meet their increased protein and energy
requirements and maintain their nutritional status.
Once people with HIV/AIDS become ill they will have special needs, which
are described below.
PEOPLE LIVING WITH HIV/AIDS HAVE INCREASED NUTRIENT NEEDS
When infected with the HIV virus the body’s defence system – the immune
system – works harder to fight infection. This increases energy and nutrient
requirements. Further infection and fever also increase the body’s demand for
food. Once people are infected with HIV they have to eat more to meet these
extra energy and nutrient needs. Such needs will increase even further as the
HIV/AIDS symptoms develop.
HIV/AIDS reduces food intake
People with HIV/AIDS often do not eat enough because:
• the illness and the medicines taken for it may reduce the appetite, modify
the taste of food and prevent the body from absorbing it;
• symptoms such as a sore mouth, nausea and vomiting make it difficult to eat;
• tiredness, isolation and depression reduce the appetite and the willingness
to make an effort to prepare food and eat regularly;
• there is not enough money to buy food.
 

HIV/AIDS reduces the absorption of food

Food, once eaten, is broken down by digestion into nutrients. These nutrients
pass through the gut walls into the bloodstream and are transported to the
organs and tissues in the body where they are needed. One of the consequences
of HIV and other infections is that since the gut wall is damaged, food does not
pass through properly and is consequently not absorbed.
Diarrhoea is a common occurrence in people with HIV/AIDS. When a
person has diarrhoea the food passes through the gut so quickly that it is not
properly digested and fewer nutrients are absorbed.
Reduced food intake and absorption lead to weight loss and malnutrition.
 

HIV/AIDS AFFECTS WEIGHT

When a person does not eat enough food, or the food eaten is poorly absorbed, the body draws on its reserve stores of energy from body fat and  protein from muscle. As a result, the person loses weight because body weight and muscles are lost.
The weight loss may be so gradual that it is not obvious. There are two basic
ways to discover whether weight is being lost.
• Weigh the person on the same day once a week and keep a record of the
weight and date (see sample sheet in Annex 4). For an average adult,
serious weight loss is indicated by a 10 percent loss of body weight or 6-7
kg in one month. If a person does not have scales at home it might be
possible to make an arrangement with a chemist, clinic or local health unit
to weigh him or her.
• When clothes become loose and no longer fit properly.
If a person loses weight he or she needs to take action to increase weight to
the normal level.
 

GAINING WEIGHT
Weight is gained by eating more food, either by eating larger portions and/or
eating meals more frequently, using a variety of foods as described in the
previous chapter. Here are some suggestions for gaining weight:

Eat more staple foods such as rice, maize, millet, sorghum, wheat, bread,
potatoes, sweet potatoes, yams and bananas.
• Increase intake of beans, soy products, lentils, peas, groundnuts, peanut
butter and seeds, such as sunflower and sesame.
• Include all forms of meat, poultry, fish and eggs as often as possible.
Minced meat, chicken and fish are easier to digest. Offal (such as kidney
and liver) can be the least expensive source.
• Eat snacks regularly between meals. Good snacks are nuts, seeds, fruit,
yoghurt, carrots, cassava crisps, crab crisps and peanut butter
sandwiches.
• Slowly increase the fat content of the food by using more fats and oils, as
well as eating fatty foods – oilseeds such as groundnuts, soy and sesame,
avocados and fatty meat. If problems with a high fat intake are
experienced (especially diarrhoea), reduce the fat intake until the
symptoms are over and then gradually increase it to a level that the body
can tolerate.
• Introduce more dairy products such as full-cream milk, sour milk,
buttermilk, yoghurt and cheese into the diet.
• Add dry milk powder to foods such as porridge, cereals, sauces and
mashed potatoes. However, do not use coffee and tea whiteners, which
do not have the same nutritional benefits as milk. Note that some people
may find milk difficult to digest. It should be avoided if it causes cramps,
a feeling of being full or skin rashes.
• Add sugar, honey, jam, syrup and other sweet products to the food.
• Make meals as attractive as possible.
• Recipes following these recommendations for gaining weight are
provided in Annex 1.
Increasing the number of meals and snacks in a day. If poor appetite persists or
the person is ill, it is a good idea to spread the food intake throughout the day.
Snacks should be included in the daily meal plan.
• A snack is any nutritious food that is readily available and can be eaten
without much preparation. Good snacks are nuts, seeds, fruit, yoghurt,
carrots, cassava chips, crab chips and peanut butter sandwiches. With at
least three meals a day and snacks in between, there is less likelihood of
malnutrition or weight loss.
• If a person needs to stay in bed, food and water should be kept within
easy reach.


Carers should ensure that sick members of the family are given
preference, fed more frequently and receive extra servings to maintain
their weight and strength. Food should be served in an attractive way.
Carers need to be kind, while frequently encouraging people to eat.
Exercise improves well-being. Regular exercise makes a person feel more alert,
helps to relieve stress and stimulates the appetite. Exercise is the only way to
strengthen and build up muscles. The body uses muscles to store energy and
protein that the immune system can draw upon when required. Exercise is
therefore especially important for maintaining the health of people with
HIV/AIDS.
It may be that everyday activities such as cleaning, working in the field and
collecting firewood and water provide enough exercise. If a person’s work does
not involve much exercise, an enjoyable exercise programme should be found
that can be part of his or her daily life. Exercise should not be tiring or stressful;
gentle muscle-building exercise is recommended. Walking, running, swimming
or dancing are all suitable. People living with HIV/AIDS need to make an
effort to find the exercise that they enjoy and that suits their situation.
Preventing weight loss during and after illness. Infection increases the body’s
requirements for nutrients. Illness also reduces the appetite and the ill person
will eat less food, causing weight loss. Recommendations for dealing with poor
appetite, diarrhoea, vomiting, sore mouth and nausea are given in Chapter six.
Early treatment of infection is important to maintain body weight. If
infection persists and cannot be cured by nutritional management within a
couple of days, advice and treatment should be sought from a doctor,
nutritionist, nurse or local health worker.
Once the infection is over and the person is feeling better, he or she should
start eating normally again. It is important to regain the weight lost as soon as
possible and to restore the body’s nutritional reserves.






INCREASE VITAMIN AND MINERAL INTAKE

Vitamins and minerals are essential to keep healthy. They protect against
opportunistic infection by ensuring that the lining of skin, lungs and gut remain
healthy and that the immune system functions properly. Of special importance
are vitamin A, vitamin C, vitamin E, certain B-group vitamins and minerals
such as selenium, zinc and iron. A mixed diet as recommended in Chapter three should provide enough of these vitamins and minerals. Some background
information on micronutrients, their nutritional role and food sources is
provided in Annex 3.

Vitamin A is important to keep the lining of skin, lungs and gut healthy. Vitamin A deficiency increases the severity of diseases such as diarrhoea while infection will increase the loss of vitamin A from the body. Good vitamin A sources are dark green, yellow, orange and red vegetables and fruit. These include spinach, pumpkin, cassava leaves, green peppers, squash, carrots, amaranth, yellow peaches, apricots, papaya and mangoes. Vitamin A is also contained in red palm oil, yellow maize, orange and yellow sweet potatoes, egg yolks and liver.

Vitamin C helps to protect the body from infection and aids in recovery. It is
found particularly in citrus fruits such as oranges, grapefruit, lemons and
mandarins. Guavas, mangoes, tomatoes and potatoes are also good sources of vitamin C.
Vitamin E protects cells and aids resistance to infection. Foods containing
vitamin E are green leafy vegetables, vegetable oils, peanuts and egg yolks.
Vitamin B-group. This group is necessary to keep the immune and nervous
system healthy. Vitamins, however, may be lost from the body through the use
of certain medicines for the treatment of tuberculosis. Good food sources
include white beans, potatoes, meat, fish, chicken, watermelon, maize, grains,
nuts, avocados, broccoli and green leafy vegetables.

Iron-deficiency anaemia is a widespread problem in many countries,
especially among women and children. Good iron sources are green leafy
vegetables, seeds, whole-grain products, dried fruit, sorghum, millet, beans,
alfalfa, red meat, chicken, liver, fish, seafood and eggs.

Selenium is an important mineral because it helps to activate the immune
system. Good sources include whole grains such as wholemeal bread, maize
and millet and dairy products such as milk, yoghurt and cheese. Meat, fish,
poultry, eggs and other protein-rich foods are also good sources, as are peanut
butter, dried beans and nuts.
Zinc is also important for the immune system. Zinc deficiency reduces the
appetite. Sources include meat, fish, poultry, shellfish, whole-grain cereals,
maize, beans, peanuts and milk and dairy products.
Further recommendations
Since the vitamin content of food can be damaged during cooking, it is better
to boil, steam and fry vegetables for a short time only. Boil vegetables in a little
water and use it afterwards for cooking as it contains considerable amounts of
vitamins and minerals. Vegetables will lose some of their vitamins and minerals
if soaked for a long time.
The skins and kernels of grains and legumes contain vitamins, in particular
of the B-group. Processed refined grains have lost many of their vitamins, minerals and proteins so whole grains such as brown bread and unrefined
cereals are better sources than white bread and refined cereals. Fortified cereals and bread are preferred because of their higher vitamin content. If a person has diarrhoea, however, whole unrefined grains and cereals should be avoided since these insoluble fibres make the diarrhoea worse. Soluble fibre foods such as bananas are recommended. Fibres are contained in many plant foods. Soluble fibres will bind water in the gut and therefore reduce diarrhoea.
 

MICRONUTRIENT SUPPLEMENTATION – WHICH, HOW MUCH AND WHEN?

When food intake is low, multivitamin and mineral supplements – often in the
form of pills – can help to meet increased requirements. However, these
supplements are often not available, they are expensive and leave less money for food. It would therefore be better to provide a good mixed diet whenever
possible rather than buy supplements.

If supplements are considered necessary, the following guidelines should be
adhered to:
• Discuss your intake of vitamin and mineral supplements with your
health worker or nutritionist.
• Always take vitamin pills on a full stomach. Be consistent and take them
regularly.
• It is probably cheaper to take a combined product with minerals rather
than several pills containing different vitamins and minerals. However,
iron may be a problem for people with HIV/AIDS as it can increase the
activity of some bacteria. Supplements that do not contain iron are
therefore better.
• Take any vitamin or mineral supplementation according to the advice on
the label. More is not better. Taking high doses can cause nausea,
vomiting, decreased appetite and liver and kidney problems as well as
interfere with the immune system. This is particularly true for vitamin A,
vitamin E, zinc and iron.
Micronutrient supplements can be useful but cannot replace eating a
balanced and healthy diet.