HIV Treatment Alerts! - October 2004
Marjorie Williams, MPH

Nutrition can affect a person's ability to survive with HIV/AIDS. Staying nutritionally fit is difficult for everyone, but for HIV+ people the task is even more challenging. Both HIV disease and HIV medications can have negative effects on nutrition. Unfortunately, keeping up with what is considered a healthy eating plan can be hard. However, there are some general nutrition guidelines for positive people to stay healthy. First, speak with a healthcare provider about what he or she recommends. Second, speak with a nutritionist that works with HIV+ people. A nutritionist can provide tailored eating plans that include all important vitamins and minerals.

Positive people should take a multivitamin daily. This has been a recommendation for quite some time, and recent research confirms that taking a multivitamin that includes vitamins B, C, and E slows the progression of HIV disease. Taking a vitamin B complex supplement has also been shown to help the body's immune system better withstand the daily assault from HIV. According to Sheila Carter, RD, a specialist in the nutritional care of individuals with HIV at Houston's Thomas Street Clinic, it is also important to make sure selenium is included in the multivitamin chosen. Selenium is a mineral that strengthens immune cells. In addition to selenium, Carter recommends L-glutamine or glutamine, a chemical found naturally in the body (and available in supplements) that aids in reducing diarrhea and wasting, as well as slowing HIV progression. Those with advanced HIV disease or AIDS tend to have low levels of selenium and L-glutamine.

Because of the dangers of wasting, especially as an AIDS-associated condition, HIV+ people should have their body cell mass (BCM) monitored by their healthcare provider. BCM is the total amount of all the cells that make up the active tissues of the body. BCM is determined based on a person's height and includes bones, muscles, and organs, as well as water inside of and between the body's cells. The loss of 54% or more of BCM can cause death in an HIV+ person—even if the person does not have an opportunistic infection. Losing weight for no apparent reason is a red flag that BCM may be decreasing. A loss of 10% of total body weight is significant and should be brought to the attention of a healthcare provider as soon as possible.

Maintaining a healthy BCM can be accomplished by eating protein, which can come from a variety of sources including meats and fish. Obviously, lean sources of protein such as chicken breast (no skin) and fish will have the greatest benefits for those who are trying to maintain heart-healthy diets. Carter recommends 100 to 150 grams of protein daily for men and 80 to100 grams daily for women.

In addition, individuals should eat complex carbohydrates such as rice or legumes (pod plants like peas or beans). High-calorie foods made from white flour or refined sugars should be eaten sparingly as numerous or excessive portions eventually may cause problems with maintaining blood sugar levels (an early sign of diabetes). Certainly, people who are insulin-resistant or who have diabetes should avoid these foods most of the time.

Fiber (found in fruits, vegetables, and whole grains) is also important, according to Carter, to prevent constipation, colon cancer, and other illnesses of the gastrointestinal system. Individuals should take at least 20 grams to 30 grams of fiber each day. Eating several servings daily of fruits and vegetables (at each meal and as snacks) is also important to provide natural sources of several vitamins and minerals. Calcium is another key nutrient and can be found in a variety of foods, including dairy, as well as in dietary supplements.

Consulting with a certified nutritionist can help you determine the best ways to incorporate adequate levels of vitamins, minerals, protein, fiber, and other essential nutrients into your daily eating. Many clinics offer nutrition services, or your healthcare provider may be able to make a referral.

RESOURCES

Consumer Labs. www.consumerlabs.com/index.asp
(Contains news on vitamins, herbs, and minerals. Some information is free, but other information requires a paid subscription.)

Body Positive Wellness Center (Houston, Texas). www.montrose-clinic.org/BodyPos.htm

Tufts University School of Medicine, HIV Nutrition and Health guide online. www.tufts.edu/med/nutrition-infection/hiv/health.html

NIH Office of Dietary Supplements. Dietary Supplement Fact Sheet: Selenium, available at: http://ods.od.nih.gov/factsheets/selenium.asp

Project Inform. Weight Maintenance available at: www.projectinform.org/fs/nutrition.html

AIDSmap. Glutamine available at: www.aidsmap.org/en/docs/8631AA14-F0D1-4DBE-9FC8-55E216DE226D.asp