Article Title:Nutrition & Diet Tips for People With HIV
Author or Credit:Lark Lands, via NZ AIDS Foundation
Published on:5th August 2002 - 05:10 pm
Story ID:4745
Text:The nutrition that goes into your mouth, from both food and nutrient supplements, can have a powerful impact for those wishing to live long and well with HIV. By improving your nutrition, you can help your body fight HIV while at the same time improving your quality of life, whether it's eliminating symptoms, improving your energy level, or increasing your overall feelings of well-being. The fundamental reason that nutrients can have such powerful effects is simple. Nutrients provide the building blocks for both the body's physical structure - its cells, tissues, and organs - and its function, including its immune response and all other aspects of its daily functioning. That would be important for anyone, but for someone living with HIV, it's particularly crucial. Why is Nutrition So Important? There are several ways that proper nutrition can help HIV-positive people remain healthy... Fighting HIV The ongoing presence of the virus means that the immune system must always be providing the immune cells and chemicals required to fight it. Since those cells and chemicals are created from nutrients, a steady supply is a must for the body's contribution to viral control. Protecting the body. Any damage to the body caused by HIV or AIDS-related infections - and by the body's immune response to the infection - must be repaired. Nutrients are the actual building materials with which the body creates and repairs itself, so there is an ongoing need for those materials. Improving quality of life Good nutrition is a must for feeling well. Optimal levels of nutrients are required for good energy and overall well-being, and for the prevention or the management of the many symptoms that nutrient deficiencies can cause (e.g., fatigue, appetite loss, skin problems, weight loss, mental changes [like memory problems or difficulty concentrating], nerve damage, muscle cramps, depression, anxiety, and many others). In addition, the presence of adequate levels of certain nutrients may actually help prevent and help reverse certain drug side effects. Thus, nutrients are an important tool for helping people to feel better and maintain a higher quality of life. Managing co-infections Many HIV-positive people also have other chronic infections to deal with, including hepatitis C and/or hepatitis B. For people with HIV and hepatitis coinfection all of the above is doubled in importance since the body must handle more than one chronic infection, and has a particular need to support the liver, and prevent it from being damaged. Unfortunately, research has shown that nutritional problems are among the first negative effects of HIV infection. These problems - inadequate intake of calories and deficiencies in certain nutrients - often get worse over time and can contribute to immune dysfunction and disease progression in multiple ways. There are several reasons why these deficiencies are common... Nutrients burn faster As discussed above, the immune system is continuously fighting HIV - even when anti-HIV drugs are being used - and repairing damage caused by the virus and other infections. This causes the body to burn nutrients faster, which can cause many nutrient levels to become low. Nutrients aren't absorbed properly Another cause of nutrient deficiencies is the poor absorption of nutrients that may occur as the result of intestinal infections (including HIV itself) or diarrhea. Some HIV-positive people have a difficult time absorbing fat, which can prevent the absorption of important vitamins like A, E, D and K. Poor diets Simply put, many HIV-positive people don't eat enough of the right kinds of foods. This may be due to fatigue, appetite loss, changes in the senses of smell or taste, nausea, vomiting, infections or other problems of the mouth or throat, or simply not knowing how to eat healthfully. Which Nutrients Are Deficient? As discussed above, it is common for HIV-positive people to have multiple nutrient deficiencies, even early on in the course of infection. Researchers have reported that, in both children and adults, deficiencies of zinc, selenium, copper, B-6, and B-12 (all of which are important for an intact immune response) are common in HIV-positive people, even before their immune system becomes damaged. In people with AIDS, nearly every specific nutrient is deficient. Researchers have also reported that these deficiencies appear to speed disease progression and that replenishing these nutrients (including B-6, B-12, and zinc) can actually help boost T-cell counts. Many other researchers have reported that deficiencies of glutathione and other important antioxidants (including vitamins C and E and the mineral selenium) are common. This is most likely because one of the body's responses to infection is the creation of unstable molecules, usually referred to as "free radicals," which are intended to destroy viruses and other disease-causing germs. These free radicals serve an important immune purpose but after their mission is carried out, they need to be countered by antioxidant nutrients in order to stop a chain reaction that could otherwise damage the body. So-called "oxidative stress" results when insufficient antioxidants are present to counter oxidative damage to cells and tissues in the body. Researchers have shown that oxidative stress is very common in both HIV disease and hepatitis C, and is a factor in progression of both diseases. Keeping optimal levels of antioxidants in the body is crucial to lessen oxidative stress and prevent body damage. The amount of this oxidative damage increases early in HIV disease, and tends to worsen over time. For example, studies have shown that decreased levels of glutathione, the most important antioxidant found in cells, occur within weeks of HIV infection. The lowered levels of glutathione lead to immune cell dysfunction in multiple ways, and allow body cells and tissues to become damaged from the oxidative stress. In fact, researchers have shown that lowered levels of glutathione are strongly tied to an increased risk for disease progression. Insufficient glutathione also means that the liver is less able to properly break down drugs and other toxins, increasing the potential for liver damage from meds. Thus, boosting glutathione levels is important for anyone living with HIV. How Can I Improve My Nutrition? There are two sources for obtaining the nutrients that can meet all the needs discussed in the previous sections: eating and drinking the right kinds of foods and liquids, and taking appropriate nutrient supplements- vitamins, minerals, amino acids and fatty acids. But it's important to know that one can't substitute for the other. Gulping down handfuls of pills won't make up for eating a bad diet, and even the best diet may not provide the level of certain nutrients that may be needed to protect and repair the liver. Thus, any information aimed at improving nutrition in HIV-positive people must begin with a discussion of diet. Only a steady intake of good food can provide not only the nutrients of which we are aware, but also the many we haven't yet discovered. Research continues to show us that nutrients about which nothing was known in the recent past may play critical roles in immune function and health preservation. And it's safe to say that there are many other nutrients still out there waiting for discovery. To ensure health, there is a critical need for all the nutrients Mother Nature designed, not just the ones we've studied so far. In addition, food contains countless "accessory" nutrients that help important nutrients work better in the body. Thus, although obtaining higher levels of certain nutrients may require the use of supplements (See "Micronutrients: Pill Power," later on in this lesson), only a healthy diet can provide the base that's absolutely necessary for health. Healthy Eating: A Pyramid of Good Food The first step in ensuring the presence of all the nutrients required to meet the needs of those living with HIV is making the most of what you eat. In the simplest terms, this means consuming a wide variety of whole foods - as opposed to processed foods or foods packaged with lots of additives or preservatives - every day, along with plenty of water and the other healthful liquids that your body needs to function at its best. Because many people find the mathematical formulas that give standard diet directions using "percentages of this" and "grams of that" too difficult to follow, many experts recommend a simpler approach for designing your meals: the food pyramid. Picture a pyramid, with layers made up of food groups. Just like any pyramid, the base is the largest and each level above that decreases in size. The idea is to eat from the bottom up, with the largest amount of your food coming from the base layer, the second largest amount from the second level up, the third largest from the third level, and so on. The Food Pyramid: A Guide to Healthy Eating Level 1 - The Bread, Cereal, Rice and Pasta Group These are the complex carbohydrates that provide a substantial portion of the day's calorie need and a lot of your energy. It is recommended that you eat 6 to 11 servings from this group daily. But don't think that this means mass quantities of carbs. The size of these servings is actually fairly small. As an example, an average serving would equal one slice of bread, one half of a bagel or English muffin, one cup of most flaky cereals, six crackers, two corn tortillas, one half cup of cooked pasta, or three squares of graham crackers. Level 2 - The Vegetable Group and the Fruit Group It is recommended that you consume 3 to 5 servings of vegetables and 2 to 4 servings of fruit daily. That's how you up the chances of getting all the nutrients and fiber that are needed for your body's healthy function, including especially its immune function. One serving of vegetables is approximately one cup of raw vegetables or one-half cup of cooked vegetables. One serving of fruit is approximately one-half cup of fresh chopped or canned fruit. Level 3 - The Meat, Poultry, Fish, Dry Beans, Eggs, the carotenoids, including beta-carotene, alpha-carotene, lycopene, the xanthophylls, and hundreds of others; the trace minerals selenium, manganese, copper, and zinc; the amino acids methionine and cysteine; and the bioflavonoids such as quercetin, hesperidin, rutin, and catechin. The body creates many antioxidants as needed, including the thiol compounds such as glutathione and alpha-lipoic acid; the hormone melatonin; the enzymes such as superoxide dismutase, glutathione peroxidase, and catalase; and the coenzymes such as coenzyme Q10. The creation of these antioxidants requires a broad spectrum of nutrients, deficiencies of any of which will sabotage the body's ability to create these antioxidants when needed. All these antioxidants are important, and one cannot generally substitute for another since they work in many different ways and in different locations in the body. Some antioxidants, like vitamin E, are fat-soluble and work predominantly in the fat-containing cell membranes, quenching lipid (fat) peroxyl radicals. Vitamin E is, in fact, the major antioxidant that protects cell membranes. However, it has little if any activity against radicals in the aqueous phase (in water; that is, the blood and other fluids). Vitamin C, on the other hand, is water-soluble and works predominantly in the watery parts of the body, particularly the blood. Alpha-lipoic acid works in both lipid and aqueous parts of the body, and works in partnership with other antioxidants, helping to recycle and regenerate them. Thus, each antioxidant is important and has a separate role in protection against oxidative stress. In addition it has been shown that all these antioxidants work synergistically, with the effects of a combination of multiple antioxidants being much greater than that from any single one. Of particular importance to HIV-positive people and those living with Hepatitis C are the nutrients that work together to raise the levels of glutathione, the intracellular antioxidant that is needed to protect cells throughout the body, improve immune cell function, and protect the liver during the breakdown of toxins. The nutrients that contribute, either directly or indirectly, to raising glutathione in the body are alpha-lipoic acid (ALA), vitamins C and E, N-acetyl-cysteine (NAC), and L-glutamine. In addition, both the B vitamins and the mineral selenium contribute to the glutathione defense system. Thus, ensuring that the body has a plentiful supply of all of these nutrients is crucial. A micronutrient supplement program should have as its base a potent multiple vitamin and mineral that will supply a basic level of all the nutrients most important to human function. This type of supplement will provide a balanced supply of nutrients in appropriate ratios for normal function. However, with all the factors discussed in the introduction that result in the multiple nutrient deficiencies that have been found in a large percentage of HIV-positive people, it may be necessary to add to the multiple a number of additional supplements in order to increase dosage levels of the nutrients most needed by people living with HIV. These would include, most importantly, higher levels of antioxidants and the nutrients used by the body to create them (vitamin E, carotenoids, vitamin C, alpha-lipoic acid, N-acetyl-cysteine, L-glutamine, Coenzyme Q10, selenium, etc.), essential fatty acids (especially the omega-3 fatty acids that are important to both immune and cardiovascular health), B12 (deficiencies of which are present in many people living with HIV, and are tied to faster disease progression, as well as chronic fatigue and memory problems), and L-carnitine or its sulfated form, L-acetyl-carnitine (which may help to counter mitochondrial toxicity in those taking HAART meds). For those coinfected with Hepatitis C, all the antioxidant nutrients are particularly important since researchers have found that oxidative stress is clearly tied to both the grade of liver fibrosis and the level of liver cell damage. Ensuring a steady supply of antioxidants may help to prevent this. Selenium, a trace mineral that is a crucial contributor to the antioxidant defense system, may be particularly important. One particularly compelling five-year study of 7,342 men who were chronic carriers of hepatitis B and/or C showed that the risk of hepatocellular carcinoma, the liver cancer that can cause death in chronic hepatitis sufferers, was much higher in those with lower blood levels of selenium. In fact, those with low levels of selenium were 47 percent more likely to develop this cancer than those with higher levels. So in addition to providing general antioxidant protection and immune defense, supplementation with selenium in doses of 200 to 400 mcg daily may provide protection against the possible development of this potentially fatal liver cancer. Studies have also shown that certain antioxidant nutrients, including vitamin E, selenium, and N-acetyl-cysteine (especially when used in combination), may improve the response to interferon therapy. For more information... For more information on nutrient needs in HIV disease and hepatitis, and specific suggestions on dosages for immune enhancement and elimination of symptoms, including some drug side effects, see the link below. This information is a slightly edited version of information written by Lark Lands, a longtime HIV disease treatment writer and educator. Lark Lands, via NZ AIDS Foundation - 5th August 2002    
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