Nutrition includes all the processes involved in eating food and how the body absorbs and uses it.
Nutrients are foods and substances (like vitamins and minerals) that enable the body to function properly and help prevent disease.
Why is nutrition so important for people with HIV/Aids?
Nutrition is an important health issue for everyone, but particularly for people living with HIV/Aids. Eating healthily and maintaining your proper weight strengthen the immune system, making it better able to slow the progression of HIV to Aids and fight opportunistic diseases.
Good nutrition also helps your body tolerate medical treatments more easily and improves your sense of well-being, which in turn strengthens your immune system.
HIV/Aids and poor nutrition
HIV/Aids and poor nutrition is a vicious circle. A combination of the following factors leads to poor nutrition in people with HIV/Aids:
1. Increased nutritional needs
When you have an infectious illness, your body's immune response to the virus uses up more energy and nutrients than normal. When opportunistic infections are present, your body needs even more nutrients.
People with HIV/Aids often need to make up for protein losses, which may result from malabsorption (the inability to take up food properly from the gut) due to diarrhoea. (See below: "Problems with digestion"). Protein loss leads to muscle-tissue breakdown.
Concerns about your health can lead to high stress levels, which affects the immune system negatively. You need higher amounts of certain nutrients during stressful periods to keep your immune system strong.
2. Decreased food intake.
- Repeated infections and fever often result in poor appetite. Medical treatments sometimes suppress appetite, as do psychological factors, such as depression and anxiety.
- Physical symptoms such as mouth and throat soreness can interfere with eating.
- Fatigue can make food preparation, and even eating, difficult, particularly in the late stage of Aids.
- Treatment costs and reduced work output due to illness may leave you with less money to spend on food.
3. Problems with digestion
HIV and other infections can damage the lining of the gut. This interferes with food digestion and absorption. Malabsorption results in diarrhoea, which in turn causes nutrient and water loss.
Good nutrition: Breaking the vicious cycle
Good nutrition means eating a balanced diet that provides you with all the necessary daily nutrients. The aims of good nutrition for people with HIV/Aids are to maintain ideal body weight, minimise muscle loss, prevent vitamin and mineral deficiencies, ensure food safety and overcome problems that interfere with nutrient intake and absorption.
Here is your seven-point plan to good nutrition:
Step 1: Pay attention to your diet as soon as you know you are HIV-positive, and continue to do so throughout the course of the disease.
Step 2: Discuss your diet and related problems with a doctor or nutritionist, preferably one experienced in counselling people with HIV/Aids. Your local Aids organisation can also advise you on where to get nutrition information and counselling.
Step 3: Eat a varied diet, which includes the following food types:
- Starchy foods, such as bread, rice, potatoes, sweet potatoes, cereals, porridge, samp, millet, corn, sorghum and pasta. These high-energy foods help keep body weight stable and should form the basis of your meals.
- Fruits and vegetables contain vitamins and other substances vital to health, and you should eat a variety of these daily. Vitamins strengthen the immune system and keep the linings of the lungs and the gut intact, which reduces the risk of infectious organisms entering the body. Eat at least some of your fruits and vegetables fresh every day; overcooking and soaking fruit and vegetables for long periods can destroy their vitamin content.
- Meat and milk products supply muscle-building proteins and strengthen the immune system. Good protein sources: meat, poultry, fish, eggs, dairy products (milk, milk powder, yoghurt, buttermilk, cheese). Edible insects like Mopani worms are also high in protein.
- Dried beans, peas, lentils, peanuts, soya, tofu and peanuts are good sources of protein too, and are especially important for vegetarians.
- Sugars, fats and oils provide energy, and should be eaten in larger amounts after infections or periods of weight loss. Apart from adding sugar to food, it can be obtained from foods made with sugar (cakes, pastries, biscuits and desserts). Fats and oils include butter, margarine, lard, cooking oil, cream, mayonnaise and salad dressings. (Note: In late-stage Aids, a high-fat diet may cause diarrhoea.)
Step 4: Exercise to build muscle. Weight loss in HIV/Aids is often due to loss of muscle mass. Simple activities, such as doing household chores and taking regular walks, help keep your muscles strong. Take it easy, however, when you're feeling ill, or have diarrhoea, a cough, fever or fatigue.
Step 5: Drink at least eight cups of fluid (water and other beverages) a day. This is particularly important if you've had diarrhoea, vomiting or night sweats, which cause water loss. (Note: Water from taps is usually safe, but water from other sources, such as rivers, should be boiled before use.)
Step 6: Avoid alcohol (wine, beer, cider, alcoholic coolers, whiskey, rum, gin, vodka, cane). It can harm the liver, particularly if you're also taking medications, causes loss of vitamins, and makes you more vulnerable to infections.
It is also less likely that you will practise safe sex when you are under the influence of alcohol.
Step 7: Get the essential vitamins and minerals. The following are particularly important:
- Vitamin Chelps with recovery from infections. Good sources include: citrus fruits (oranges, grape fruit, lemons), guavas, mangoes, tomatoes, potatoes.
- Vitamin A helps keep the linings of the skin, lungs and gut healthy. Infections increase loss of vitamin A from the body. Good sources: dark green, yellow, orange and red fruits and vegetables, such as spinach, broccoli, pumpkin leaves, green peppers, sweet potato, squash, pumpkin, carrots, yellow peaches, apricots, paw-paws, mangoes. Animal sources include: liver, butter, cheese, eggs.
- Vitamin B6 helps maintain healthy immune and nervous systems. It is lost from the body when a person takes certain medicines for TB. Good sources: white beans, potatoes, meat, fish, chicken, watermelon, maize, grain, nuts, avocado, broccoli, green leafy vegetables.
- Selenium, found in whole grain foods like whole wheat bread, bran flakes, corn, samp and millet; and protein-rich foods like milk products, meat, fish, poultry, eggs, peanuts, dried beans and nuts.
- Zinc, found in: meat, fish, poultry, shellfish, whole grain cereals, corn, beans, peanuts; dairy products.
Flavonoids and phytosterols are natural substances, found mainly in fruits and vegetables, which boost the immune system. Sources of flavonoids: citrus fruits, apples, berries, red grapes, carrots, onions, broccoli, cabbage, cauliflower, brussels sprouts, peppers, green tea.
Phytosterols are found in a variety of foods, including seafood, peas, nuts, seeds (sunflower and sesame) and whole grains.
Vitamin and mineral supplements do not make up for a nutritious diet: foods contain many substances vital for health not found in vitamin pills. Nevertheless, it may be helpful to take a vitamin-mineral supplement, given that HIV infection does increase the body's need for certain vitamins and minerals. Tips for taking supplements:
- Take vitamin pills on a full stomach.
- It is generally better to take one multivitamin and mineral tablet daily rather than several pills containing different substances.
- Don't take more than recommended on the package or by your doctor. High doses can cause nausea, vomiting, decreased appetite and liver and kidney problems. Excessive intakes of zinc and vitamin A can decrease immunity.