Comprehensive, up-to-date information on HIV/AIDS treatment, prevention, and policy from the University of California San Francisco

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 6 classes of nutrients, each with its own special role in the body:

		Protein builds muscles and a strong immune system.

		Carbohydrates (including starches and sugars) 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.

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.

If you are underweight--or you have advanced HIV disease, high viral loads, or opportunistic infections--you should include more protein and extra calories (in the form of carbohydrates and fats). You'll find tips for doing this in the next section.

If you are overweight, you should follow a well-balanced meal plan such as the ones presented on the U.S. government's Choose My Plate website (http://www.choosemyplate.gov/).Being overweight puts extra stress on your body and increases the risk of heart disease, high blood pressure, and diabetes.

Weight loss is a common problem for people infected with HIV, and it should be taken very seriously. Weight loss can be caused by HIV-related infections or conditions or by untreated HIV itself. 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.

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 (such as scrambled eggs, casseroles, and milkshakes).

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 (eg, 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, such as 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.

		Do not drink 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, such as Gatorade.

		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 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.

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 in no way replace eating a healthy diet, which is the best source of the vitamins, minerals, and other nutrients your body needs. Large doses of vitamins and supplements are usually not necessary and, in fact, can be potentially toxic as well as expensive.

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 health care provider before taking high doses of any supplement.

		Some people experience nausea with multivitamins, even if taken on a full stomach.

		Iron-containing supplements can be constipating. Drink extra water and increase your fiber intake to help minimize constipation. If your provider has recommended iron-containing supplements and you cannot tolerate them, talk to your provider about other ways to increase the iron in your diet (see table below).

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

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 a product if its expiration date has passed.

		Rinse all fresh fruits and vegetables with clean water before eating.

		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 the meat is fully cooked. Put the thermometer in the thickest part of the meat, not touching a bone. Cook the meat until it reaches 165-212 degrees F. on the thermometer.

		Do not eat raw, soft-boiled, or "over easy" eggs, or Caesar salads with raw egg in the dressing. This includes eating uncooked cookie dough or cake batter that contains uncooked eggs.

		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 F. 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 and parasites are spread through tap water. If your public water supply isn't totally pure and you have advanced HIV, it may be advisable to drink bottled or filtered water until your immune system gets stronger.

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

Below are some tips for dealing with common problems facing people living with HIV. 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, such as crackers, before getting out of bed. Keep something in your stomach; eat a small snack every 1-2 hours. Discuss with your care provider how best to take your medications to avoid nausea--some HIV medicines (for example, protease inhibitors) should be taken on a full stomach, whereas others (for example, efavirenz) should be taken on empty stomach. Avoid foods such as the following: 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 (such as 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 such as 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 liquids Limit sodas and other sugary drinks. Avoid greasy and spicy foods. High-fat foods can make diarrhea worse in some situations. Avoid milk and other dairy products. Eat small meals and snacks every hour or two. Talk to your provider about medicines you are taking that may cause diarrhea and how to minimize this--for example, taking protease inhibitors with food may reduce medication-associated diarrhea.

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 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 doctor can usually refer you to a dietitian or nutritionist who can help design a good diet for you.

For general guidelines on good nutrition, you can visit the U.S. government's Choose My Plate website (www.choosemyplate.gov/).