for Veterans and the Public

Diet and Nutrition and HIV: Entire Lesson

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:

• Protein builds muscles and a strong immune system.
• Carbohydrates (including vegetables, fruits, grains) give you energy.
• Fat gives you extra energy.
• Vitamins regulate body processes.
• Minerals regulate body processes and also make up body tissues.
• 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 boost your immune system. But there are things you can do to keep your immunity up.

When you are infected with HIV, your immune system has to work very hard to fight off infections--and this takes energy (measured in calories). This means you may 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). You'll find tips for doing this in the next section.

If you are overweight, find help on MyHealtheVet's Healthy Eating Center. Keep in mind, you may need to eat more food to meet your extra needs.

Weight loss is a common problem for people infected with HIV, and it should be taken very seriously. 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 HIV often do not eat enough because:

• HIV and HIV medicines may reduce your appetite, make food taste bad, and prevent the body from absorbing food in the right way
• symptoms like a sore mouth, nausea, and vomiting make it difficult to eat
• fatigue from HIV or the 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 steamed vegetables.
• Eat yogurt on your cereal or fruit.
• Eat hard-boiled (hard-cooked) eggs. Use them in egg-salad sandwiches or slice and dice them for tossed salads.
• 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).

To add calories to your diet

The best way to increase calories is to add carbohydrates and some extra fat to your meals.

Carbohydrates include both starches and simple sugars.

Starches are in:

• breads, muffins, biscuits, crackers
• oatmeal and cold cereals
• pasta
• potatoes
• rice

Simple sugars are in:

• fresh or dried fruit (raisins, dates, apricots, etc)
• jelly, honey, and maple syrup added to cereal, pancakes, and waffles

Fats are more concentrated sources of calories. Add moderate amounts of the following to your meals:

• butter, margarine, sour cream, cream cheese, peanut butter
• gravy, sour cream, cream cheese, grated cheese
• avocados, olives, salad dressing

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.

Drinking enough liquids is very important when you have HIV. 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 Gatorade or Sprite.
• 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.

For more information, see the symptoms and medication side effects section.

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 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:

• Always take vitamin pills on a full stomach. Take them regularly.
• Some vitamins and minerals, if taken in high doses, can be harmful. Talk with your VA health care provider before taking high doses of any supplement.

On the following page is a table of some vitamins and minerals that affect the immune system.

Name	What It Does	Where to Get It	About Supplements
Source: Adapted from the Food and Agriculture Organization of the United Nations
Vitamin A and beta-carotene	Keeps skin, lungs, and stomach healthy.	liver, whole eggs, milk, dark green, yellow, orange, and red vegetables and fruit (like spinach, pumpkin, green peppers, squash, carrots, papaya, and mangoes). Also found in orange and yellow sweet potatoes	It's best to get vitamin A from food. Vitamin A supplements are toxic in high doses. Supplements of beta-carotene (the form of vitamin A in fruits and vegetables) have been shown to increase cancer risk in smokers.
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.	citrus fruits (like oranges, grapefruit, and lemons), tomatoes, and potatoes
Vitamin E	Protects cells and helps fight off infection.	green leafy vegetables, vegetable oils, and peanuts	Limit to 400 IU per day.
Iron	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	Limit to 45 mg per day unless otherwise instructed by your doctor. Iron may be a problem for people with HIV because it can increase the activity of some bacteria. Supplements that do not contain iron may be better. Ask your VA doctor.
Selenium	Important for the immune system.	whole grains, meat, fish, poultry, eggs, peanut butter, and nuts	Limit to 400 mcg per day.
Zinc	Important for the immune system.	meat, fish, poultry, beans, peanuts, and milk and dairy products	Limit to 40 mg per day.

Print table

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 have a past 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. If your public water supply isn't totally pure, drink bottled water.

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 BRATT Diet (Bananas, Rice, Applesauce, Tea, and Toast).
• Try some ginger--in tea, ginger ale, or ginger snaps.
• 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 to your mouth.
• Do not eat spicy foods. They can sting your mouth.
• Try soft foods like mashed potatoes, yogurt, and oatmeal.
• Also try scrambled eggs, cottage cheese, macaroni and 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 acid and can sting your mouth.

Diarrhea

• Try the BRATT Diet (Bananas, Rice, Applesauce, Tea, and Toast).
• Keep your body's fluids up (hydrated) with water, Gatorade, 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 hour or 2.
• Try taking Glutamine protein powder to help repair the intestinal lining.

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.
• When you are HIV-positive, you may need to eat more. Be sure to eat a diet that is high in proteins and calories.
• 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. If your tap water isn't pure, drink bottled water.
• You can use certain foods and beverages to help you deal with symptoms and side effects.
• Before taking vitamin and mineral supplements, check with your VA health care provider.

Remember, there is no one "right" way to eat. Eating well means getting the right amount of nutrients for your particular needs. Your VA health care provider can refer you to a dietitian or nutritionist who can help design a good diet for you.

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/.

• MyHealtheVet's Healthy Eating Center
  Advice on how to get started and maintain healthy eating habits.
• Choose My Plate
  Choose My Plate is a program that can help you choose the foods and amounts that are right for you. It replaces the Food Pyramid, from the U.S. Department of Agriculture.
• Health Care and HIV: Nutritional Guide for Providers and Clients
  Source: HRSA HIV/AIDS Bureau
• Living well with HIV/AIDS: A manual on nutritional care and support for people living with HIV/AIDS
  Source: Food and Agriculture Organization of the United Nations
• Fact sheet on nutrition and exercise when you have HIV
  Includes tips on exercises for strength training, from the American Academy of Family Physicians.