With HIV, Eating Right Means Eating More

While nutrition is a year-round obsession for many people in the United States, at no other time than the New Year and the months leading to swimsuit season do so many people resolve to eat “better” and lose weight to improve their figure and / or their health.

This may be a worthy goal for most of the population, but HIV-positive people must realize that while good nutrition and a healthy lifestyle are indeed essential parts of their treatment regimen, weight loss is not.

Fighting the virus places the metabolism under high energy demands. If these demands are not met by eating adequate amounts of food, muscles and body-fat stores are burned up to provide the necessary energy, causing weight loss and weakness. Thus, the first priority of an HIV-infected person must be to eat enough food to prevent muscle wasting and to sustain the challenged immune system.

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Food provides essential nutrients--such as protein, fat, carbohydrates, vitamins and minerals--and dieting, by limiting food intake, increases the risk of not meeting the body’s needs for these nutrients. Just as a car cannot run without gas, the body cannot fight an infection without food.

The nutritional needs of an HIV-positive person do change with medical status, depending on whether one is HIV-infected but otherwise without symptoms, or whether one is fighting an active infection with the associated fevers, decreased appetite and unintentional weight loss. At such times, extra pounds are just like a spare tank of gas or savings in the bank.

If you are HIV-positive with no symptoms, the general principles of good nutrition apply: Eat a balanced diet including moderate amounts of fat, plenty of breads and starches, vegetables and fruits, and protein-rich foods; those are very important to maintain your muscle mass and strength. They include meat, poultry, fish (including canned fish), eggs (and egg substitutes), dairy products (milk, yogurt, cottage cheese, cheese and ice cream--regular or low fat), and nuts (peanut butter, for example) or soy products.

Make sure that you eat three meals a day, and that you include some of these high-protein foods at each meal.

A multivitamin and a mineral supplement are also recommended to ensure that you get all the nutrients you need. Research suggests that vitamin B complexes and antioxidants (vitamins C and E and beta-carotene), omega-3 fatty acids (from fish oils) and selenium, among others, may be of particular benefit when fighting an HIV infection.

During or after fighting a major infection, which usually results in weight loss, your nutritional priority should be to increase your caloric intake to recover your strength.

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Remember that vegetables, because they provide very few calories and make you feel full rapidly, are not as important when your needs are so high. Choose rich foods such as ice cream, milkshakes, protein smoothies, puddings and cream soups to help regain weight and recharge your batteries.

If you have an intolerance to dairy products, consume lactose-free milk and ice creams. These protein foods are essential to help you maintain your muscle mass and replenish your immune system. You must try to eat as much as possible, even if you feel poorly. Your body needs that fuel.

Try taking a little bit of food at a time, several times a day. Sips of fruit nectars, protein smoothies and shakes, bites of peanut butter and crackers, and handfuls of dried fruits and trail mix will all add up to provide calories and protein until you feel better.

If you feel very sick or are really having trouble eating enough, high-calorie, high-protein nutritional drinks may be appropriate until you are able to tolerate regular foods in sufficient quantities. If your caloric intake remains poor despite your efforts, your doctor may then choose to prescribe an appetite stimulant to help boost your natural hunger mechanisms.

If diarrhea is a problem, make sure you drink plenty of fluids, preferably juices or sports beverages, to provide extra calories. Eat plain white rice, bananas, canned fruits, applesauce and also Gummi Bears.

You may need to temporarily avoid milk products until the diarrhea is controlled. Use nondairy creamers and soy-based or lactose-free products as substitutions to keep up your protein intake.

If you have mouth sores or difficulty swallowing because of a sore throat or dry mouth, choose moist, soft foods and add gravies or sauces. This will help increase your caloric intake while making foods smoother and easier to swallow.

Finally, a very important issue for people with HIV is food safety.

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Food-borne illnesses can easily be avoided by following a few simple rules:

* Never eat raw or undercooked protein foods such as shellfish (oysters, clams, mussels), ceviche, sushi, carpaccio, poached eggs or Caesar salads with raw eggs in the dressing. All of these have higher risks of bacteria-related food poisoning, which is harder to fight when your immune system is weakened.

* Avoid soup and salad bars where food has been sitting out for long periods of time.

* At home, wash raw fruits and vegetables thoroughly, and make sure you use only pasteurized dairy products.

* When shopping, check the dates on food containers to ensure freshness.

Remember that eating well is an essential part of your treatment plan because of the strong link between your nutrition and the ability of your immune system to fight the disease.

While diet and reduced-calorie foods may be appropriate for the general population, they are not suitable for an HIV-positive person whose goal should be to sustain the immune system with sufficient calories and protein. Eating “better” may mean eating more rather than less.

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* Marianne Friedman, a registered dietitian, is a clinical dietitian at Huntington Memorial Hospital in Pasadena, where she works with patients at the Phil Simon Clinic, a program that cares for people with HIV / AIDS.