Dietary Management of HIV-Aids
Diet And Nutrition
The role of good nutrition in the management of HIV/AIDS has assumed increasing importance over the past decade. In fact, medical research has shown that nutritious food is one of the most powerful weapons available for fighting the often-calamitous effects of AIDS. Furthermore, it has been clinically confirmed that malnutrition is the fatal manifestation of AIDS for many of the people who succumb to the disease. People living with AIDS may require up to twice the normal daily caloric intake to protect themselves from the dangers of HIV-related malnutrition: heightened immunosuppression, muscle wasting, and outright starvation due to malabsorption and abnormal metabolism of nutrients. In addition, appropriate dietary modifications can significantly reduce both the side effects of medications and the symptoms of opportunistic infections.
Although the recent emergence of protease inhibitors offers new hope for effective treatments, these advances—for those who can afford them—will only increase the importance of proper nutrition. Even the most promising combination therapies have side effects, which can be reduced by proper nutrition. Additionally, proper nutrition takes on an added importance when considered in conjunction with the effect that diet has on the absorption of certain medications by the body. In those cases where the new treatments prolong the lives of people living with HIV/AIDS, the number of long-term survivors of the disease will grow, increasing the number of people who could benefit significantly from proper nutrition.
Good nutrition means getting enough macronutrients and micronutrients. Macronutrients contain calories (energy): proteins, carbohydrates, and fats. They help you maintain your body weight. Micronutrients include vitamins and minerals. They keep your cells working properly, but will not prevent weight loss.
Good nutrition can be a problem for many people with HIV. When your body fights any infection, it uses more energy and you need to eat more than normal. But when you feel sick, you eat less than normal.
Some medications can upset your stomach, and some opportunistic infections can affect the mouth or throat. This makes it difficult to eat. Also, some medications and infections cause diarrhea. If you have diarrhea, your body actually uses less of what you eat.
When you lose weight, you might be losing fat, or you might be losing lean body weight like muscle. If you lose too much lean weight, your body chemistry changes. This condition is called wasting syndrome or cachexia. Wasting can kill you. If you lose more than 5% of your body weight, it could be a sign of wasting. Discuss it with your doctor.
Persons with inadequate nutrition who are HIV positive, manifest symptoms such as nausea, vomiting, malabsorption, diarrhea, oral/esophagealid disease progression. Even when nutritional intake is adequate, an HIV-positive person may lose weight long before he or she develops AIDS. This happens because, throughout the progression of HIV ined have an increased to opportunistic infections and a more rapstatus is challenged by the fectiosusceptibilityn, the patient`s nutritional problems, and infections that impede fat storage. People with HIV may also develop lactose intolerance. After HIV infection has progressed to AIDS, malabsorption of nutrients may become severe. Weight loss can cause a vicious cycle of fatigue, muscle wasting, and loss of appetite. Nutritionists and dieticians work with people with HIV infection to design diets that provide those nutrients that may be lacking. Some practitioners work within mainstream medicine, while others have unique approaches.
It is important to know that many of the physical symptoms associated with HIV can be made better or made worse by the food one eats. The right foods to eat for one problem may be exactly the wrong foods to eat for another. If one has more than one problem, it can be difficult to know what to eat. Always try to ask the doctor for advice on what is best for your condition.
The benefits of good nutrition and exercise are well worth the effort, especially for people living with HIV. At the July community forum, Jan Zimmerman, a nutritionist at the Village Center for Care AIDS Day Treatment Program, and Sean Crawford, a clinical exercise specialist, shared valuable information about the ways in which diet, supplements, and exercise contribute to overall health and HIV treatment.
In her presentation entitled `Building Health and Healing with HIV/AIDS`, Jan Zimmerman provided practical advice about food and supplement choices. These choices are just one part of healthy living, however, Zimmerman views emotional and spiritual health as the foundation for health and healing. You can use support groups, conversations with friends, meditation, or church, among other resources, to support your emotional and spiritual health, but your emotional health must be well established before you undertake healing nutrition and exercise. The final component of health and healing, especially in HIV disease, is medication and side effect management. These three elements of health and healing must be practiced daily.
HIV nutrition specialists can help you do more than just gain or lose weight. They can provide guidance on both HIV-related and medication-related ailments, including appetite loss, bloating/gas, diarrhea, kidney disease, lipodystrophy, and wasting. Some of these conditions can be treated without pharmaceutical interventions.
Zimmerman explained the general principles of Nutritional Healing in HIV/AIDS upon which she bases her practice:
1. Maintain normal body weight. Be aware of the caloric intake you need to achieve and maintain a normal weight.
2. Build muscles/maintain lean body mass (avoid wasting). Use strength training and, if necessary, steroids or hormones to build/maintain muscle mass.
3. Optimize digestion. The digestive tract is your center of health—simple steps like chewing your food carefully can make its job much easier! Eating 4-6 small meals is more efficient than eating 1-3 large meals.
4. Eat more `healing foods`, fewer processed foods.
5. Drink 6-10 cups of non-caffeinated fluids daily.
6. Use supplements rationally and consistently.
7. Address social and emotional isolation, as these factors can negatively influence your food choices.
Dietary supplements are commonly used in an effort to boost the immune system. Foods or substances derived from foods (garlic, Chinese bitter melon, and turmeric) are used, as well as nonfood dietary supplements such as shark cartilage or blue-green algae (spirulina). Vitamins, minerals, and amino acids are also used in an attempt to boost the immune system.
Supplements can be beneficial as just that: supplements to a well balanced healing foods diet. Supplements are not a substitute for the vitamins in food. If you`d like to start taking supplements, consult with an HIV nutrition specialist to help you develop a supplement regimen that meets your needs. In general:
• Use supplements consistently for 6-8 weeks in order to see results.
• Never take supplements on an empty stomach: they will be absorbed more effectively if you take them with food.
• Tell your primary care provider about the supplements that you are taking.
Some specific supplement suggestions are:
• Protein/Calorie (Boost, Ensure, etc.)
Use: weight gain
*not for people with severe thrush or yeast infections
• Protein Powders (whey, glutamine, soy)
Use: increase protein intake (can help build/preserve muscle mass)
*not for people with severe liver or kidney disease
• Therapeutic Multivitamins
Use: provides 100% of the recommended daily allowance of many vitamins
This is the only supplement directly related to improved mortality in HIV infection. The recommended daily allowance can be obtained in 1-2 Brazil nuts or in pill form.
• Alpha Lipoic/Thioctic Acid
Good for liver detoxification and neuropathy relief.
Use: preserves bone, muscle, and nerve function
May help treat diarrhea.
• Coenzyme Q10
Use: support body`s energy pathways
May aid in mitochondrial toxicity from long-term antiretroviral use.
For further information on nutrition`s role in HIV care, Ms. Zimmerman recommends reading Healing HIV: How to Rebuild Your Immune System by Jon Kaiser and Nutrition and HIV: A New Model for Treatment by Mary Romeyn.
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AIDS stands for acquired immunodeficiency syndrome. A diagnosis of AIDS is made by a physician using certain clinical or laboratory standards.
American Institute of Preventive Medicine