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Proper nutrition in the treatment of HIV is critical.
Because HIV and its associated medications have such a distressing
effect on the body, it is important to understand how a proper diet
will support people living with HIV, and permit them to maintain
healthy lives.
In this article we will elaborate on the importance
of proper nutrition to the HIV individual and how effective it can be
when combating its associated issues. We will also provide a foundation
from which the individual can learn, and take action towards an improved,
healthier and sustainable life.
WHAT IS NUTRITION?
The human body is incredible and dynamic, and
when given the right tools it will accomplish miraculous things.
It is therefore our goal to provide the body with all of the
essential nutrients in order for it to operate effectively and
undergo its natural processes like the growth and repair of cell
structures and body tissues, and provide us with the required
energy for our level of activity. Nutrition involves the intake of
vitamins, minerals, water, sugars, fats and proteins. It is the amount
and quality of the foods we eat, the fluids we drink, and the dietary
supplements we take, which allows us to optimize our nutritional status,
overall wellbeing, and keep diseases at bay.
Our metabolism relates to the body's output. It is the
rate at which the body uses energy to function properly on a daily basis.
This may be influenced by many factors, including the types and amounts of
food ingested, our activity levels and the amount of lean muscle tissue in
our bodies.
What are the basics?
It is essential to know the basic components of
food in order for us to combine the right types at the right times,
and in proper proportions. This will empower the body to run smoothly.
The following is a breakdown of the food groups:
- Macronutrients:
- Carbohydrates are the primary sources of Energy,
provide vitamins and minerals and fibre.
- Complex - whole grains, pastas, rice, breads
- Simple - fruits and vegetables
- Fibre - legumes, mature root vegetables, other vegetables and
fruits, oats, breads, they are responsible for pushing the food along the
digestive tract and allowing for greater absorption of the precious vitamins
and minerals into the bloodstream
- Proteins are responsible for the growth and repair of body
tissues, and act as a secondary source of Energy.
- Complete - eggs, fish, chicken, red meat, dairy products
- Incomplete - breads, rice, pasta, nuts, seeds, legumes
- Fats are involved in the transportation of Vitamins ADEK,
the formation of cell membranes & chemicals, the transmission of nerve
impulses and the regulation of body temperature. They are also a source
of Energy at lower intensity levels.
- Good - Polyunsaturates and monounsaturates - cold water
fatty fish, flax seed & oil, safflower oil, nuts and seeds,
- Bad - Saturated fats - meats, dairy, coconut oil
- Ugly - Trans fats - hydrogenated oils, processed foods
- Micronutrients:
- Vitamins & Minerals build body tissues, metabolize
Carbs, Proteins and Fats, promote healing and good health, support the
immune system, and help to build strong bones.
- Water is the carrier of nutrients & oxygen via the
blood stream, eliminates waste products & toxins, regulates the body
temperature & acts as a lubricant for the joints.
HOW DOES HIV AFFECT THE BODY WITH REGARDS TO NUTRITION?
HIV infects the cells that line the gastrointestinal tract and
can make eating, digestion, absorption and elimination painful, difficult and less
effective. Furthermore, the prescribed medications often negatively impact the body's
digestive cycle. As a result, malnutrition will often occur with people
who are HIV positive.
Wasting, when a person is underweight, has lost muscle mass
or is losing weight without wanting to, is also a concern. Malnutrition and
wasting can be caused by four general factors. Any of these problems should be
addressed with your doctor and you should be speaking with a registered dietician:
- Loss of Appetite: Suffering from a loss of appetite due to depression,
infection, medications, fatigue, diarrhea or nausea is common among people
living with HIV. Other individuals may experience pain or difficulty chewing,
tasting or swallowing. This will result in a lower intake of calories and
vital nutrients.
- Malabsorption: This occurs when foods are not getting broken down into
their basic components or cannot be carried from the digestive system to
the rest of the body. Malabsorption is caused by medications, malnutrition
or infection. Diarrhea and vomiting are also a cause of malabsorption.
In this case the food and liquid do not get completely absorbed into the system.
As a result of the above-mentioned, the body is not able to make use of the
vitamins and minerals being ingested and is prone to sickness and disease.
- Increase in metabolism: It is also important to consider that the
metabolism will increase and the body will expend more energy when fighting
off an infection. One would have to boost their caloric intake and eat more
than they are accustomed to in order to maintain their ideal strength,
health and weight.
- Lack of Activity and Exercise: The "use it or
lose it" concept is true. Changes in activity can occur when there are
changes in work or social routines. Also, the individual may not feel
mentally or physically well enough to keep up to their usual physical
activity or exercise. As a result atrophy sets in and weight loss occurs
through the decrease in the size of cells, tissues, and organs.
Therefore people living with HIV are at risk of the following:
- Loss of weight
- Decreased energy levels
- Increased risk of disease, ie: diabetes, cardiovascular/heart disease
- Decreased overall sense of well-being
SO WHAT IS THE SOLUTION?
The underlying goal for people who are HIV positive is
the optimization of the nutritional status and overall well-being. With the
realization that the medications and the infection can make eating anything
at all difficult, it is therefore considered essential that everything ingested
is chock-full of nutrients. Nutrition is the one area where people living with
HIV have major control. The daily decisions they make will have a profound
impact on their nutritional health. In addition to helping delay disease
progression, good nutritional health helps to maintain a healthy immune
system, reduces complications from HIV, achieves maximum benefit from drug
therapies and increases ones energy levels. Therefore what is eaten makes a
very real difference in how the individual feels and how well they do medically.
- Eating healthy is still only one part of the equation. The individual must
also be taking supplements to support the eating, as well as regular weight
bearing exercise to help maintain lean body mass.
The following are goals that people living with HIV should establish and maintain:
A - THE PREVENTION OF THE DEVELOPMENT OF SPECIFIC NUTRIENT DEFICIENCIES
It is important to provide the body with an
abundance of vitamins and minerals that will enable it to perform
its necessary functions. Because of decreased food intake and/or
malabsorption people living with HIV are at risk of not obtaining
the full complement of vitamins and minerals. These are the tools
critical to the body's operation! As a result, the individual is
highly susceptible to sickness, disease, ill health and low energy levels.
1 - Fluid Intake: People taking
HIV medications should drink plenty of liquids to ensure that the drugs
are properly absorbed and working efficiently and that the excess medication
is excreted along with other bodily toxins. Fluids also help to flush
the liver which processes the medications, and act as a carrier of
nutrients & oxygen via the blood stream.
If an individual is losing fluids through night
sweats, diarrhea, or vomiting they must replace the lost water. It is
important that they drink plenty of water in order to
maintain good hydration.
2 - Supplements: Vitamins and
minerals provide the fine-tuning for cells to function properly and
help release energy from foods. Supplements are sometimes needed by
people with HIV to prevent deficiencies. Vitamin pills do not provide
energy or protein and cannot replace nourishing food; however they
serve to complement its missing elements.
The following vitamin and mineral supplements
should be considered: (consult your doctor 1st)
- or immune support - B-complex vitamins (25-50mg) are highly recommended.
They can be found in sprouted grains and brewer's yeast.
- For antioxidant protection - Vitamin C (500-1000mg) and Vitamin E (400IU).
Vitamin C can be found in fruits and vegetables, and Vitamin E can be found
in grain germs, seeds, nuts and vegetable oil.
- To help build and protect bones - Calcium (1000-1500mg). Dairy products are
loaded with Calcium; therefore a supplement may not be necessary.
Calcium is also found in broccoli and tofu.
Other supplements to consider:
- To aid in the formation of proteins, act as a messenger
in the nervous system, red blood cells, the proper functioning of a
large number of enzymes and in maintaining a good immune system - Vitamin B 12.
This can be found in sprouted grains and brewer's yeast. It can also be taken in
shot form or nasal spray.
- A mineral antioxidant - Selenium. This can be found in chicken,
seafood and whole grains. As a supplement it should be taken in small
doses as it may become toxic.
- A vitamin which aids in vision and acts as an antioxidant - Vitamin A.
This can be found in sprouted grains, orange and yellow
fruits and vegetables and dairy products. Because it is a fat soluble
vitamin, it may be toxic if taken in high doses.
- An antioxidant that plays a role in protecting the cell
membrane, helping with bone marrow toxicity, fats and the immune
system - Vitamin E. This can be found in grain
germs, seeds, nuts and vegetable oils.
- For aid in Calcium absorption and healthy heart functioning -
Magnesium. This can be found in green leafy vegetables,
oysters, beans and nuts.
Selecting the appropriate vitamins and minerals can
be very complex. Most are actually toxic if taken in large enough amounts.
Before taking any new pills, obtain enough information to answer these
three questions: Could it help me? Could it hurt me? Can I afford it?
These micronutrients can and may also interact
with medicines an individual is taking. It is therefore important to
communicate these decisions with the doctor and registered dietician
with regard to the right amounts.
NOTE: If there are health concerns, such as
hepatitis C, one must be especially careful about supplementation.
Get advice from the HIV healthcare providers about specific needs.
A note on meds.
HAART medications work better if you follow the instructions about
food consumption. Food can affect absorption and metabolism (how much
drug is in your system and how fast it clears). Medications usually
cause fewer side effects if taken with the right amount of food.
Speak with your primary care physician or a dietician who specializes
in HIV nutrition for more information.
B - THE PREVENTION OF THE LOSS OF WEIGHT AND LEAN BODY MASS
People living with HIV will have a greater tendency to
lose weight. Therefore they must make the proper adjustments to their diet
and exercise program in order to build and maintain.
1 - Calories & Ratios: For starters they will
have to focus on an increased caloric intake as the metabolism is
working harder at fighting off the infection. Furthermore, it is
recommended that the individual eat a particular ratio of Carbs,
Proteins and Fats that will allow them to maximize their efforts of
weight gain and maintenance:
- 45% of ones calories should come from Carbohydrates.
Carbs provide the necessary energy to perform the weight bearing
exercises. If one is not getting in enough, the body will "catabolise"
or eat away at the protein and muscles of the body as a secondary source
of energy. This is not good as we want to increase the muscle mass, not
lose it. Whole grains, pastas, brown rice, vegetables and fruit are
perfect examples of what to eat. These are 'time release' energy
sources and are a good source of fibre which helps with nutrient
absorption.
- 30% of the calories should
come from Protein. Protein helps build and maintain
the muscles. Great examples are: milk products, meats,
poultry, fish, soy milk, tofu, legumes, eggs and nuts.
Because HIV causes the body to create and destroy
cells more rapidly, the body requires more protein
than the average person. People who are HIV+ and in
good health, should increase their protein intake
by approximately 30%.
- 15% of the calories should come from Fats. They provide additional
energy and are important in the formation of cell membranes and the
absorption of Vitamins ADEK. The fat intake should be focused on Polyunsaturates
and Monounsaturates. These include: nuts, seeds, canola, safflower and olive
oils, fish and avocados.
Additional eating tips:
- Eat often. Try eating every 3 hours, which equates
to five to six meals per day. This is the most important thing one
can do to ward off wasting.
- Make every bite count. Consider food as medicine
and chose nutritious foods from a variety of sources.
- Drink at least 3 cups of milk or soy milk
to boost your protein intake.
- Consume nutritional drinks and energy bars.
These products are full of nutrients and minerals. Use them as
snacks between meals.
- Choose calorie dense fluids, such as juice,
milk, and nutritional drinks
- Avoid alcohol and smoking, which will cause
or aggravate nausea.
2 - Weight Bearing Exercise: This is crucial
for the gain and maintenance of muscle mass. Regardless of the diet,
if there is no weight training, then there will be no stimulation for
growth and no muscle gains. When performing weight training, we create
millions of microscopic tears in the muscle fibres. Following this up
with the right amount of protein to feed them and ample rest for growth,
the muscles will repair themselves and grow larger. This is the basis
for gaining lean body mass.
If you are considering an exercise program,
it is recommended that you consult with a Personal Trainer to ensure
safety, proper technique and effective programming. The following are
tips for a workout program for muscle growth:
- performing a full body workout
3 times per week, with a day's rest in between each
workout. Perform 3 sets of 8-12 reps for each muscle
group.
- It is important to train the muscles until fatigue sets in.
This means that by the final rep of each set the individual should
not be physically able to lift the weight another time either
because of the burning sensations in the muscles or because of
muscle weakness. This technique stimulates the tearing of the
fibres and releases growth hormone into the system which is
necessary for repair and growth.
- Immediately after the workout one should have a health
shake consisting of protein powder, fruit and milk or water.
The body at this point in time is very receptive to the sugars
from the fruit and will readily absorb them. This will increase
the muscles' sugar stores and provide additional stamina for the
next workout. The protein from the shake will turn the body switch
from catabolic to anti-catabolic. This means that the muscles will
stop to break down. It is when we are sleeping that the body goes
into its anabolic phase where we can repair and build.
C - THE REDUCTION OF THE RISK FOR ONSET
OR COMPLICATIONS OF DIABETES AND CARDIOVASCULAR/HEART DISEASE
If people living with HIV are not getting the proper
nutrition and exercise, they will eventually become susceptible to the
onset of disease. Among others, these diseases are in the form of
diabetes and cardiovascular/heart disease.
1 - Diabetes: In type I diabetes,
the symptoms usually progress quickly and are often dramatic.
In type II however, the symptoms are slower to progress. In many
cases, the sufferer does not show any symptoms at all. These people
may find out that they have type 2 diabetes when they go to the doctor
for another, unrelated problem. Below are some symptoms that a diabetes
sufferer may encounter:
- Fatigue
- Frequent urination
- Unusual thirst
- Unexplained weight loss
- The Health Risks of Diabetes:
Diabetes is a lifelong condition. It is correlated with high blood
glucose levels for a prolonged period of time over ones life. Health
risks associated with diabetes are:
- blindness
- heart disease
- reduced blood supply to the limbs, leading to amputation
- nerve damage
- erectile dysfunction
- stroke
Although there is no cure for diabetes, this
condition can be managed by medication and/or insulin, and by
making healthy lifestyle choices which include glucose tolerance.
Some tips to consider are:
- Limiting sugar and refined, white carbohydrates, ie: white breads, pastas, rice
- Including the right types and amounts of dietary fats, ie: polyunsaturates, monounsaturates
- Ensuring adequate protein intake
- Having smaller portions during meals, and eat every 3-4 hours
- The starch intake during meals should be based on blood sugar levels before and 2 hours after a meal
- Including chromium and vanadium supplement with each meal. (consult with your doctor)
2 - Cardiovascular/Heart Disease: Cardiovascular
disease or heart disease is the number one killer in Canada.
It is also the most costly disease in Canada, putting the greatest
burden on our national health care system. Men are generally more
likely to develop heart disease. An increasing number of women are
experiencing heart disease but they are under-diagnosed. For both
sexes, the risk of heart disease increases with age. A number of
factors, individually or in combination, can lead to heart disease:
- Smoking
- Diets rich in saturated fat
- Physical inactivity
- Stress
- A family history of heart disease, and
- Being overweight
Medical conditions such as high blood pressure,
high blood cholesterol, obesity and diabetes are also potent risk factors.
Notes on managing High cholesterol:
-Limit sugar and refined, white carbohydrates
-Include the right dietary fats, i.e. flax oil, cold water fish, olives,
avocado, raw nuts, raw nut butter (peanut, almond or cashew)
-Eliminate bad dietary fats: saturated animal fats and hydrogenated fat
(typically found in processed, long shelf-life convenience foods like
popcorn, snack cakes, salad dressings and margarines)
-Improve fiber in take
-Add quality assured supplements including fish oil or non-flush niacin
-Increase physical activity
- Here are some heart healthy tips to consider:
- Don't smoke: Not smoking or quitting
smoking reduces your risk of developing heart disease and not
smoking may help to increase the "good" cholesterol in your blood.
It also reduces your risk of having a heart attack, stroke,
and common cancers.
- Eat a wider variety of foods: According to Canada's Food Guide to
Healthy Eating, as part of a balanced diet, we should enjoy a variety of foods
and choose lower-fat foods more often.
- Get moving: As little as 60 minutes a day of accumulated physical
activity will help keep your heart in shape. Not sure how to start? Try the
Physical Activity Guide for some ideas.
- Avoid fad or miracle diets: Eating well and staying physically
active will help you to control your weight.
- Have regular medical check-ups that include measurement of your
blood cholesterol level: You can also be tested for diabetes, one of the major
risk factors for heart disease.
These foundations will provide Energy, growth,
the ability to repair tissues and regulate body functions.
WITH ALL OF THIS NEW INFORMATION, WHERE DO I START?
Making new changes to our lifestyle can be very
daunting; it may often seem that we are alone in our endeavors. That is
why it is important to develop our own support groups to help us along
the way. Involving friends and family is a great way to get started.
Hiring a Personal Trainer for the weight training program will ensure
safety, efficiency and offer that extra motivation. Consulting with a
nutritionist will provide the necessary nutritional foundation. To help
look at things from a greater perspective and ensure balance and long
lasting benefits, seek out a life coach. Help is everywhere!
Remember, if you are living with HIV, then you are at risk of:
- Loss of weight
- Decreased energy levels
- Increased risk of disease, ie: diabetes, cardiovascular/heart disease
- Decreased overall sense of well-being
Try focusing on the following:
- 1 - The prevention of the development of specific nutrient deficiencies
- 2 - The prevention of the loss of weight and lean body mass
- 3 - The reduction of the risk for onset or complications of diabetes, cardiovascular/heart disease
The human body is incredible and dynamic,
and when given the right tools it will accomplish miraculous things!
Credits
Jeff Dubé
Citrus Health Inc.
citrus@sprint.ca
For specific information about nutrition & fighting weight loss:
www.medibolics.com
www.tbrewi.com/hivfitness
www.larrylands.com/lark
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