Improving a Person’s Nutrition

Although HIV (human immunodeficiency virus) may not be prevalent in some communities when it comes to infectious diseases, they are amongst the top 10 deaths worldwide, especially in lower-income countries:

The Top Ten Leading Causes of Death: The rank number is from high to low worldwide deaths, followed by -> Low-Income Countries versus High-Income Countries

1. Heart disease/Lower respiratory infections/Heart disease
2. Stroke/Diarrheal diseases/Stroke
3. COPD/Heart disease/Alzheimer’s disease
4. Lower respiratory Infections/HIV/AIDS/Lung cancers
5. Alzheimer’s disease/Stroke/COPD
6. Lung cancers/Malaria/Lower respiratory infections
7. Diabetes/Tuberculosis/Colon cancers
8. Road injury/Preterm birth complications/Diabetes
9. Diarrheal diseases/Birth asphyxia and trauma/Kidney diseases
10. Tuberculosis/Road injury/Breast cancer

–World Health Organization (2018)

The purpose of discussing nutrition is because people who are mentally ill may also have lower sources of income or dealing with infectious diseases. Overall, nutrition can either help or hinder a person’s healing process. Therefore, this post is just a quick understanding of the importance of diet and nutrition, especially related to HIV which can be applied to other diseases. Also, read about:

• Elderly/Adult Nutrition Plate & HIV Resources (at the bottom)
• Mental Health & Nutrition (pdf)
• The Benefits of Tea
• Websites about Medical Conditions

Why is Nutrition Important?

Nutrition is important for everyone because food gives our bodies the nutrients, they need to stay healthy, grow, and work properly. Foods are made up of six classes of nutrients, each with its own special role in the body:

1. Protein builds muscles and a strong immune system.
2. Carbohydrates (including vegetables, fruits, and grains) give you energy.
3. Fat gives you extra energy.
4. Vitamins regulate body processes.
5. Minerals regulate body processes and also make-up body tissues.
6. Water gives cells shape and acts as a medium where body processes can occur.

Having good nutrition means eating the right types of foods in the right amounts so you get these important nutrients.

Do I Need a Special Diet?

There are no special diets, or particular foods, that will directly boost your immune system. But there are things you can do to keep your immunity up.

When you are infected with HIV or have an infection, your immune system has to work very hard to fight off infections–and this takes energy (measured in calories). For some people, this may mean you need to eat more food than you used to.

If you are underweight–or you have advanced HIV disease, high viral loads, or opportunistic infections–you should include more protein as well as extra calories (in the form of carbohydrates and fats) in your diet.

How do I keep from losing weight?

Weight loss can be a common problem for people with relatively advanced stages of HIV infection, and it should be taken very seriously. It usually improves with effective antiretroviral therapy (ART). Losing weight can be dangerous because it makes it harder for your body to fight infections and to get well after you’re sick. People with advanced HIV often do not eat enough because:

• HIV may reduce your appetite, make food taste bad, and prevent the body from absorbing food in the right way. Some HIV medicines may also cause these symptoms (if this is so, tell your HIV specialist–you may be able to change to medications that do not have these side effects).
• symptoms like a sore mouth, nausea, and vomiting make it difficult to eat
• fatigue from HIV or medicines may make it hard to prepare food and eat regularly

To keep your weight up, you will need to take in more protein and calories. What follows are ways to do that.

To add protein to your diet

Protein-rich foods include meats, fish, beans, dairy products, and nuts. To boost the protein in your meals:

• Spread nut butter on toast, crackers, fruit, or vegetables.
• Add cottage cheese to fruit and tomatoes.
• Add canned tuna to casseroles and salads.
• Add shredded cheese to sauces, soups, omelets, baked potatoes, and vegetables.
• Eat yogurt with your cereal or fruit.
• Eat hard-boiled (hard-cooked) eggs in your salads.
• Eat beans and legumes (pinto and other beans, lentils, etc), nuts, and seeds.
• Add diced or chopped meats to soups, salads, and sauces.
• Add dried milk powder or egg white powder to foods like scrambled eggs, casseroles, and milkshakes.

Extra Nutritional Tips

When you become ill, you often lose your appetite. This can lead to weight loss, which can make it harder for your body to fight infection. Here are some tips for increasing your appetite:

• Try a little exercise, like walking or doing yoga. This can often stimulate your appetite and make you feel like eating more.
• Eat smaller meals more often. For instance, try to snack between meals.
• Eat whenever your appetite is good.
• Avoid drinking too much right before or during meals. This can make you feel full.
• Avoid carbonated (fizzy) drinks and foods such as cabbage, broccoli, and beans. These foods and drinks can create gas in your stomach and make you feel full and bloated.
• Eat with your family or friends.
• Choose your favorite foods and make meals as attractive to you as possible. Try to eat in a pleasant location.

How much water do I need?

Drinking enough liquids is very important when you have HIV or an infection. Fluids transport the nutrients you need through your body. Extra water can:

• reduce the side effects of medications
• help flush out the medicines that have already been used by your body
• help you avoid dehydration (fluid loss), dry mouth, and constipation
• make you feel less tired

Many of us don’t drink enough water every day. You should be getting at least 8-10 glasses of water (or other fluids, such as juices or soups) a day. Here are some tips on getting the extra fluids you need:

• Drink more water than usual. Try other fluids, too, like noncaffeinated teas, flavored waters, or fruit juice mixed with water.
• Avoid colas, coffee, tea, and cocoa. These may contain caffeine and can actually dehydrate you. Read the labels on drinks to see if they have caffeine in them.
• Avoid alcohol.
• Begin and end each day by drinking a glass of water.
• Suck on ice cubes and popsicles.

Note: If you have diarrhea or are vomiting, you will lose a lot of fluids and will need to drink more than usual.

Do I Need Supplements?

Our bodies need vitamins and minerals, in small amounts, to keep our cells working properly. They are essential to our staying healthy. People with HIV may need extra vitamins and minerals to help repair and heal cells that have been damaged.

Even though vitamins and minerals are present in many foods, your health care provider may recommend a vitamin and mineral supplement (a pill or other form of concentrated vitamins and minerals). While vitamin and mineral supplements can be useful, they can’t replace eating a healthy diet.

If you are taking a supplement, here are some things to remember:

• Do not take vitamin pills on an empty stomach.
• Some vitamins and minerals, if taken in high doses, can be harmful. Talk with your VA provider before taking high doses of any supplement.
• Some minerals (like calcium, magnesium, and iron) may interfere with certain HIV medicines — talk with your provider about whether or when to take these minerals.

Below is a table of some vitamins and minerals that affect the immune system.

Vitamin	Purpose	Sources
Vitamin A and beta-carotene; It's best to get vitamin A from food. Vitamin A supplements are toxic in high doses.	Keeps skin, lungs, and stomach healthy	Liver, whole eggs, milk, spinach, pumpkin, green peppers, squash, carrots, papaya, and mangoes. Also found in orange and yellow sweet potatoes
Vitamin B-group (B-1, B-2, B-6, B-12, Folate)	Keeps the immune and nervous system healthy.	White beans, potatoes, meat, fish, chicken, watermelon, grains, nuts, avocados, broccoli, and green leafy vegetables
Vitamin C	Helps protect the body from infection and aids in recovery.	Oranges, grapefruit, or lemons, tomatoes, and potatoes
Vitamin D	Important for developing and maintaining heathy bones and teeth.	Fortified milk, fatty fish, sunlight
Vitamin E; Limit to 400 IU per day.	Protects cells and helps fight off infection.	Green leafy vegetables, vegetable oils, avocados, almonds
Iron; Limit to 45 mg per day unless otherwise instructed by your doctor.	Not having enough iron can cause anemia.	Green leafy vegetables, whole grain breads and pastas, dried fruit, beans, red meat, chicken, liver, fish, and eggs
Selenium; Limit to 400 mcg per day.	Important for the immune system.	Whole grains, meat, fish, poultry, eggs, peanut butter, and nuts
Zinc; Limit to 40 mg per day.	Important for the immune system.	Meat, fish, poultry, beans, peanuts, and milk and dairy products

–Food and Agriculture Organization

What Should I Know About Food Safety?

Paying attention to food and water safety is important when you have HIV because your immune system is already weakened and working hard to fight off infections.

If food is not handled or prepared in a safe way, germs from the food can be passed on to you. These germs can make you sick.

You need to handle and cook food properly to keep those germs from getting to you. Here are some food safety guidelines:

• Keep everything clean! Clean your counters and utensils often.
• Wash your hands with soap and warm water before and after preparing and eating food.
• Check expiration dates on food packaging. Do not eat foods that are past the expiration date.
• Rinse all fresh fruits and vegetables with clean water.
• Thaw frozen meats and other frozen foods in the refrigerator or in a microwave. Never thaw foods at room temperature. Germs that grow at room temperature can make you very sick.
• Clean all cutting boards and knives (especially those that touch chicken and meat) with soap and hot water before using them again.
• Make sure you cook all meat, fish, and poultry “well done.” You might want to buy a meat thermometer to help you know for sure that it is done. Put the thermometer in the thickest part of the meat and not touching a bone. Cook the meat until it reaches 165 to 212 degrees Fahrenheit on your thermometer.
• Do not eat raw, soft-boiled, or “over easy” eggs, or Caesar salads with raw egg in the dressing.
• Do not eat sushi, raw seafood, or raw meats, or unpasteurized milk or dairy products.
• Keep your refrigerator cold, set no higher than 40 degrees. Your freezer should be at 0 degrees.
• Refrigerate leftovers at temperatures below 40 degrees F. Do not eat leftovers that have been sitting in the refrigerator for more than 3 days.
• Keep hot items heated to over 140 degrees F, and completely reheat leftovers before eating.
• Throw away any foods (like fruit, vegetables, and cheese) that you think might be old. If food has a moldy or rotten spot, throw it out. When in doubt, throw it out.
• Some germs are spread through tap water. Check the quality of your public water supply or drink bottled water.

Can Diet Help Ease Side Effects and Symptoms?

Many symptoms of HIV, as well as the side effects caused by HIV medicines, can be helped by using (or avoiding) certain types of foods and drinks.

Below are some tips for dealing with common problems people with HIV face. You should also look in the side effects section for more information.

Nausea

• Try the BRAT Diet (Bananas, Rice, Applesauce, and Toast).
• Try some ginger–in tea, ginger ale, or ginger snaps (these need to be made with real ginger root).
• Don’t drink liquids at the same time you eat your meals.
• Eat something small, like crackers, before getting out of bed.
• Keep something in your stomach; eat a small snack every 1-2 hours.

Avoid foods like

• Fatty, greasy, or fried foods
• Very sweet foods (candy, cookies, or cake)
• Spicy foods
• Foods with strong odors

Mouth and swallowing problems

• Avoid hard or crunchy foods such as raw vegetables.
• Try eating cooked vegetables and soft fruits (like bananas and pears).
• Avoid very hot foods and beverages. Cold and room temperature foods will be more comfortable for your mouth.
• Do not eat spicy foods. They can sting your mouth.
• Try soft foods like mashed potatoes, yogurt, oatmeal, scrambled eggs, cottage cheese, and canned fruits.
• Rinse your mouth with water. This can moisten your mouth, remove bits of food, and make food taste better to you.
• Stay away from oranges, grapefruit, and tomatoes. They have a lot of acids and can sting your mouth.

Diarrhea

• Try the BRAT Diet (Bananas, Rice, Applesauce, and Toast).
• Keep your body hydrated with water or other fluids (those that don’t have caffeine).
• Limit sodas and other sugary drinks.
• Avoid greasy and spicy foods.
• Avoid milk and other dairy products.
• Eat small meals and snacks every 1-2 hours.

Points to Remember

• You may feel that many things are out of your control if you have HIV. But you can control what you eat and drink, and how much. Good nutrition is an important part of your plan to stay well.
• Eating right can make your body and your immune system stronger.
• If you are underweight or chronically ill, you may need to eat more. Be sure to eat a diet that is high in proteins and calories.
• If you are overweight, you may need to lose some weight to be healthier.
• Exercise can stimulate your appetite and make you feel like eating more.
• Drink plenty of liquids to help your body deal with any medications you are taking. If you are vomiting or have diarrhea, you will need to drink more than usual.
• Practice food safety. Keep your kitchen clean, wash foods, and be careful about food preparation and storage.
• You can use certain foods and beverages to help you deal with symptoms and side effects.

Remember, there is no one “right” way to eat. Eating well means getting the right amount of nutrients for your particular needs. For general guidelines on good nutrition, you can follow the U.S. Government’s Choose My Plate Guide. Check it out here: http://www.choosemyplate.gov/.

–U.S. Dept. of Veterans Affairs

Things to consider

What can I do if I’m having trouble eating?

• If you don’t have an appetite —Try to eat your favorite foods. Instead of eating 3 big meals each day, eat 6 to 8 small meals. Drink high-calorie protein shakes with your meals or between meals.
• If you have diarrhea — Don’t eat fried foods and other high-fat foods like potato chips. Also, avoid high-fiber foods. Instead, eat bland foods such as bread, rice, and applesauce. Ask your doctor about taking nutritional supplements, such as Ensure.
• If you have mouth sores — Avoid citrus fruits like oranges and grapefruit. Avoid very hot or cold foods. Don’t eat spicy foods. Try not to eat hard foods like chips and pretzels. Use a straw to drink liquids.
• If you have nausea and vomiting — Avoid drinking any liquid with your meals. Eat 6 to 8 small meals each day instead of 3 large meals. Eat foods with a mild flavor. Eat foods at a medium temperature, not too hot or cold. Drink nutritional supplements and sports drinks. Sit and relax for 30 minutes after you eat.

Questions for your doctor

• Am I healthy enough to begin an exercise program?
• Are there certain foods I should be eating?
• Are there any dietary supplements I should be taking?
• Are there other things I should be doing to boost my health?
• Is there anything else I can do to prevent complications/infections?

–Family Doctor

Healthy Eating Plate

–Harvard

Nutrition for Older Adults

–Tufts

Resources About HIV

National HIV Curriculum:  The National HIV Curriculum is a FREE educational website that provides ongoing, up-to-date information needed to meet the core competency knowledge for HIV prevention, screening, diagnosis, and ongoing treatment and care to healthcare providers in the United States. Also find resources from the National Inst. of AIDS, AIDS MAP (UK) & CDC. Additional resources include:

1. American Academy for HIV Medicine
2. HIV Medicine Association
3. International Association of Providers of AIDS Care
4. Association of Nurses in AIDS Care
5. International AIDS Society