Positive Living Series
Understanding and Dealing With Your Medical
- General Nutrition
- Fighting HIV Symptoms with Food
- Cooking and Eating Defensively
- Tips for Shopping
- Tips for Cooking
- Dining Out
- Pregnancy and Nutrition
- Food Gimmicks - What to Watch Out For
- Don't Deprive Yourself
- Drugs and Alcohol
- Taking Care While Traveling Internationally
- Vaccines for Traveling
Good nutrition is important for everyone. A balanced diet keeps our bodies strong and our immune systems healthy, making it harder for us to get sick. HIV positive people are more susceptible to infectious agents in food and water, so it is especially important to follow safe cooking guidelines, drink water that has been purified, and be careful when dining out. Additionally, it is important for you now to maintain your body weight and muscle. Finally, people with illnesses like HIV and cancer often hear and read about diets which claim to "cure" illness, and though it can be hard to resist these promises, it is important to avoid being taken advantage of.
Individual needs can vary when you have HIV so you may want your medical provider to refer you to a registered dietician who has experience working with HIV positive people. Changes in your health status may require more (or less) calories in your diet. Your dietician can help you achieve this with a balanced diet. In addition, the combination anti-retroviral therapies require a strict regimen regarding food intake, which can greatly affect your individual nutritional needs.
The "Eating Right Pyramid" (on the next page) shows what we've all been taught about the basic food groups, but in a visual format. The basic message for HIV positive people is to eat a variety of foods and get regular exercise in order to maintain a healthy weight while conserving lean body muscle.
Quick GuideHIV AIDS Facts: Symptoms and Treatments
Grains and cereal provide a variety of vitamins and minerals. They also provide some fiber, protein and carbohydrates. Try to get between six and eleven servings per day. One serving is a slice of bread, a cup of cereal, or a half-cup of pasta, rice or grits.
To make oatmeal or grits more interesting add dried fruits, milk, or grated cheese. If you have a freezer and a toaster, frozen waffles make a great quick meal or snack. You can always add fruit on top to help boost your daily fruit intake. Try cold macaroni salad with added vegetables, a chopped hard-boiled egg and dressing. All of these combinations boost protein and might help fight food boredom.
Fruits and Vegetables
Fruits and vegetables are rich in vitamins, minerals and fiber, and serve as good cleansers for your intestines. They are full of water, which can help quench your thirst, and research has suggested that eating fresh fruits and vegetables may offer some protection against strokes and cancer. However, cut back on fresh fruits and vegetables if you are having diarrhea.
A good goal is to eat three to five servings of fruit and vegetables each day. A serving of fruit is one piece of raw fruit or a cup of canned fruit; fruit juices are good for you but they don't count as a serving. One serving of vegetables is one half cup of cooked or a whole cup of raw vegetables.
Fruit is a perfect snack. You can always carry a banana, apple, or orange with you for when you get hungry on the run. Adding raisins to cereal is another way to boost your intake. Canned fruit is also great because you can get it any time of year. The nutritional value may be a little lower, but it still counts. The fruit cocktail "snack packs" in the stores are great things to keep around or throw in your purse or backpack for when you get a craving. Boxed fruit juice (100% juice) is another good traveling companion. In summertime, freezing juice in ice cube trays is a great way to beat the heat.
Vegetables are a wonderful source of fiber and vitamins. Melting cheese on top of broccoli or other vegetables not only adds some zip, but gives you extra protein, too. Carrots and celery are a great snack and, like fruit, can be carried with you almost anywhere for when you get the urge to eat. They provide lots of fiber but almost no calories. Salads can be very tasty; just add cheese or cooked beans, tuna or hard-boiled eggs. All of these things not only make your vegetables more exciting, but they boost the protein, and our main goal is to keep body weight stable. Potatoes are another wonderful vegetable option. Mashed potatoes are great with extra cheese and milk added in. Try new kinds of potatoes, like sweet potatoes or yams. When it comes to variety in your diet, more is better.
Meats and Beans
Meat and vegetarian substitutes provide your body with the energy that it needs. Additionally, red meat, fish and poultry are excellent sources of iron, which may prevent anemia, especially in women.
Two or three servings a day of extra-lean beef, fish, seafood, poultry, cheese or beans will give your body a lot of protein and vitamins and minerals. One serving is three ounces of meat, seafood, fish or poultry (about the size of a deck of playing cards); two eggs or two ounces of cheese; one cup of dried beans, peas or nuts, or four tablespoons of peanut butter. If you don't eat meat, it will be important that you increase your protein intake by eating more tofu, nuts, eggs and beans. If you have any questions about whether you're getting enough protein, be sure to ask your health care provider or dietician.
Dairy products are an excellent source of calcium and protein. Two or three servings a day of milk or other dairy products provides minerals and protein. One serving is a cup of milk, one-and-one-half ounces of cheese, or two cups of yogurt, cottage cheese or ice cream.
Dairy products can be added to many foods. Use milk to make your favorite puddings. Use milk instead of water to make hot chocolate. Add extra cheese to pizzas. Mix ice cream with milk and maybe some fruit for a terrific milkshake. Add canned milk or dried milk to mashed potatoes, cornbread or pancakes for an extra dose of protein. And remember that chocolate milk gives you just as much protein as regular milk.
Some people do not tolerate lactose, a sugar found in milk and other dairy products, and HIV can also increase a person's lactose intolerance. Symptoms of lactose intolerance include gas pain, diarrhea or cramping after eating or drinking a dairy product. If you think dairy products may be the source of some physical problems, juggle your diet around a bit, reduce your dairy intake and see if this helps. You can also buy milk with reduced lactose in many grocery stores.
A general rule to follow is to limit fat intake to less than 30% of your total diet. A low fat diet is not necessarily advocated, but keep in mind there is good fat and there is bad fat. Limit your intake of saturated fats and eat in moderation those foods containing essential fatty acids, like those found in fish, avocados and nuts.
Quick GuideHIV AIDS Facts: Symptoms and Treatments
Water is essential for your body. It's important to drink at least eight glasses a day. It's also important that the water be safe. Some opportunistic infections, such as cryptosporidiosis, can be contracted from bad water. Drinking untreated water from streams or lakes is dangerous for everyone. Most areas in the US do not have contaminated water supplies, but it still would be safest to drink treated water, especially if you have a low CD4 cell count. The best option is to boil tap water for 1 full minute. Another more expensive option is to filter your water with a filter that attaches to your faucet or under your sink. Make sure the filter is capable of removing particles less than 1 micron in size. The best filters in this category produce water by reverse osmosis, are labeled as "Absolute" 1 micron filters, or are labeled as meeting the ANSI/NSF International standard #53 for "cyst removal." Watch for these descriptions on filtered water and filtering products. Use disposable gloves when changing the filter cartridges. Bottled water is another option, if purified by distillation or reverse osmosis.
Vitamins and Nutritional Supplements
Many people take vitamins. Though it is recommended that you first try to get your nutritional needs met with a well balanced diet, there are times when vitamins are needed to "fill the gap." Do not take the attitude "if one vitamin is good, then two or three would be even better." Having too much of some vitamins can harm your health. The current recommendation is to take one or two multi-vitamins per day with less than 10-mg. iron. Be sure to tell your health care provider about your current vitamin intake.
There are many products on the market (such as Ensure and Advera) that have proven to be reliable sources of nutrients for people with HIV or AIDS. These supplements, which often come in liquid form, can be great food on the run, if you don't feel like cooking, or if you just want to boost your protein a bit. It's important to remember these products are not meant to replace meals, they are supplements. It is very important that you maintain a balanced diet to the best of your ability.
Fighting HIV Symptoms with Food
Diarrhea is a fairly common problem, and becomes even more so with HIV disease. If you have chronic diarrhea, it's even more important that you get good nutrition and liquids into your body. Check with your health care provider to see if any parasites or your medications may be causing the diarrhea. Here are some nutrition suggestions for helping to reduce diarrhea:
- Avoid high fiber foods such as raw vegetables, fresh fruits, dried beans, and bread, cereal or pasta made from whole grain because they will make your stools looser. Eating white bread, white rice and pasta is helpful because they are processed and they will stay with you better. Potatoes, applesauce, canned fruits, cooked cereals, melons and skinless fruits are all good options. Avoid prunes or any other fruit with seeds.
- Avoid hot spices - peppers, chili powder or Tabasco can make diarrhea worse.
- Try to stay away from foods that cause gas, such as beans, broccoli, cabbage, green peppers and onions.
- Avoid citrus fruits and try to drink fruit nectars, such as apricot, instead.
- Switch to decaffeinated drinks. Caffeine will make food and water go through your system faster.
- If you are at all lactose intolerant, you will probably be experiencing a lot of bloating, gas and cramping. You might try a lactose reduction aid like Lactaid, or stay away from dairy products until the diarrhea passes.
- Sometimes greasy or fried foods, butter and oils can cause diarrhea. There are now a lot of fat free foods on the market you may want to try.
Diarrhea causes dehydration so drink lots of fluids. Try to drink eight or more glasses of juice or calorie-rich liquids each day. Water is best. Severe diarrhea can cause a lack of protein. Check with your health care provider to make sure that you are getting enough protein in your diet.
For most people, feeling sick and throwing up is related to infection, stress, medication or medical treatment. If nausea lasts for more than two days, call your health care provider. Here are some tips for dealing with nausea:
- Drink clear and cool beverages; sip them slowly using a straw.
- Eat small amounts of food many times during the day - a few mouthfuls
- Eat bland foods such as potatoes, rice, bread, noodles and fruit. It's good to go by the "BRAT" formula: bananas, rice, applesauce and dry toast.
- Avoid skipping meals - an empty stomach will make you feel sicker.
- Avoid fried or greasy foods, very sweet foods, spicy foods, and strong-smelling food.
- Do not lie down for at least one hour after eating.
Unfortunately, the mouth is a breeding ground for all sorts of opportunistic diseases. And since that's where your food goes first, the infections can be a real annoyance and can keep you from getting the nutrition you need. Fortunately, thrush and other mouth infections can be treated with medicine and sometimes by a change in diet. Here are a few suggestions to help with eating if you have a mouth infection:
- Don't eat food with a lot of acid in it. Stay away from lemons, limes, tomatoes, oranges, grapefruits, etc. Apple juice, milk, soy or rice milk, and supplements will reduce a lot of the sting that you might get from more acidic foods.
- Try to avoid carbonated drinks (soda pop, sparkling water), hot coffee or tea, and alcohol because they can cause severe mouth pain.
- To relieve dry mouth caused by medication try gum, hard candy, or breath spray. Avoid candy and chewing gum containing Sorbital - it may cause diarrhea.
- Eat softer foods like stews, casseroles, ice cream, bananas, etc. If a food is too hard, make it softer. Try dipping your bagel in coffee or your cookies in milk. Add butter and cream sauces to pasta dishes; this makes them easier to chew and swallow.
- Ice cream, popsicles or ice cubes can numb your mouth for a while andn provide some relief.
Quick GuideHIV AIDS Facts: Symptoms and Treatments
Weight loss is common and can be a serious problem in HIV disease. Sometimes what seems like a few pounds lost can quickly turn into twenty or thirty pounds. It is very difficult to regain this weight. If you experience a loss of 10-15 pounds without intending to do so, consult your doctor or a nutritionist.
You might want to consider nutritional supplements such as Ensure. You need as many calories as possible and these drinks are easy to carry around with you. If you haven't already, check with your health care provider to figure out which supplement is best for you. Additionally, health care providers can prescribe an appetite stimulant if they feel it is needed.
Cooking and Eating Defensively
People with HIV get sick more often from food-borne illnesses than other people. Everyone can get food poisoning, but people with weakened immune systems can get a lot sicker. Once someone with HIV gets sick from a food-borne illness, it can be very hard to treat and can come back again and again.
Know how to protect yourself from food-borne illness. Diseases such as salmonella, botulism or hepatitis-A can cause serious infections or even death. Most of these diseases are caught directly from an infected person, but you can also be infected by raw or poorly cooked food, improperly canned food, food contaminated by insects, and food that has been handled by someone who has not followed proper food handling practices.
Cook food thoroughly to kill bacteria and germs. Red meat is not properly done for someone with HIV until it is brown; fish should flake; egg whites and yolks should be firm, not runny; and chicken juices should be clear, not pink.
Tips for Shopping
Know your market. Are you comfortable with how clean and fresh the meat, produce and dairy products are? Does your market put raw meat next to raw or lightly steamed fish or shellfish? These are unsafe practices. If you are uncomfortable with the conditions and you can change stores, do so. If you can't change to another store, ask the market manager directly about how things are kept and ask how the store complies with guidelines for food-borne illness regulation.
Read the labels on packages and cans, not only for nutritional values, but to make sure you are buying them before their expiration date. Stay away from the carts overflowing with on-sale cans that fell off the display and are dented. Dented cans are often a sign of contaminated food.
If you have any questions about your store, you should always feel comfortable asking. People are usually more than happy to help.
- ALWAYS wash your hands before and after you touch or prepare food.
- Wash all of your fresh fruit and vegetables to get rid of chemicals, pesticides, and infectious microbes such as E. Coli.
- Double bag fish, chicken, and packaged meat and place them in the freezer if you don't plan to use them right away. This will help keep bacteria from growing.
- NEVER cut raw meat or poultry on
the same surface that you use to cut fruit and vegetables.
This is very dangerous because raw meat is often
contaminated with bacteria.
- Whether you're using a microwave or a conventional oven, follow the directions carefully. Allow for plenty of standing time after cooking because the food is still cooking. Use a meat thermometer rather than guess. Shortcuts can lead to illness.
- Fill a spray bottle with water and a capful of bleach. Have it handy for cleaning counters and cutting boards.
- Always wash the tops of cans before opening them to avoid getting germs in your food.
Food safety problems are especially scary when you are in a restaurant because you have little or no control over how food is prepared. Since you don't know who is handling your food, or how, the best thing you can do is to remember this motto: Boil it, cook it, peel it, or forget it!
Don't take chances dining out. It's smart to ask how a particular dish is prepared and whether it contains raw ingredients. It's good to stay away from creamy salad dressings if you're not sure they're fresh - remember that Caesar dressing often has raw egg in it. Stay away from anything prepared with raw eggs (eggnog, hollandaise sauce). Stay away from sushi and steak tartar. If your steak is too rare, or if your chicken is pink near the bone, SEND IT BACK. Don't let a surly waiter or waitress make you feel bad. You are paying for the food and it should be prepared in a way that is safe for you.
Pregnancy and Nutrition
If you're pregnant, it is even more important to keep your body strong. This will help you maintain energy and will reduce infections, making your pregnancy easier. Most pregnant women need to gain about 30 pounds during their pregnancy to help the baby get to a healthy weight. Following the basic nutritional guidelines is a great start toward keeping you and your baby healthy. If you notice you aren't gaining weight or that you are having trouble keeping your diet balanced, check in with your health care provider for some good suggestions on helping you gain weight. Your health care provider will also recommend a prenatal vitamin pill for you and your baby. It's very important to tell your health care provider if you are taking any other vitamins because too many vitamins may be harmful to your baby.
Food Gimmicks - What to Watch Out For
It's important to be careful when you are shopping for diet supplements. There are a lot of products out there that will claim to "cure it all" when in fact they don't have a lot of important nutrients. On the other hand, there are some good diet supplements on the market that could be helpful in making sure your diet is balanced. If a product seems too good to be true, it probably is. If the answer is "yes" to any of the questions below, it would be wise to look into the product further before buying it. Contact your health care provider or a dietician.
- Does the promoter of the product, book or diet leave out entire food groups?
- Does the research provided mostly consist of personal stories from people who swear that they "have been healed" by this product? Though it is tempting to believe these claims, more often than not they are exaggerations.
- Are there nutritional claims made in the pamphlets but not on the product labels or in the advertising? You should know that the government regulates claims made in advertising and on labels but NOT on other printed materials, so these pamphlets can claim anything.
- Does the promoter of the product have a financial or personal motive to deceive you?
Don't Deprive Yourself
These nutritional guidelines may seem limiting, but they are just the building blocks for a healthy body. It's very common to feel resistant to giving up things you enjoy and that help you relax. It's important that you still feel freedom to indulge yourself occasionally. The word on the street is to use alcohol and caffeine in moderation. A glass of wine or a cup of coffee may be one of your greatest pleasures and should not be cause for alarm. If you're craving a piece of double chocolate cake for dinner, GO FOR IT; there will always be string beans later. It's critical that you don't feel completely deprived.
Drugs and Alcohol
It is no big secret that drugs and alcohol are bad for your immune system and your health when used in large quantities. Drinking a lot can suppress the immune system, increase the toxicity of your medications, and damage your liver. Smoking irritates the lungs and can leave you more susceptible to serious lung infections like pneumonia. Uppers like speed, crystal and cocaine can damage the immune system and give a false sense of energy, leaving the body exhausted. And any drug you buy off the streets may be cut with something even more dangerous than the drug itself.
Be sure to tell your health care provider(s) about your drug or alcohol use. Without this information, they could misdiagnose your symptoms or prescribe a drug that could worsen your condition. Of course, your health care provider may encourage you to quit or cut down, but don't let this stop you from getting the medical care you need.Cutting Down or Quitting - While stopping the use of alcohol or drugs is usually the best way to maintain or improve your health, abstinence is not a realistic goal for everyone. If this is true for you, then decreasing the amount and frequency of your tobacco, drug, or alcohol consumption is still a positive step toward better health and may be more manageable. Some people have managed alcohol addiction by limiting the number of drinks they allow themselves. The same is true of some heroin users.
Substituting other activities for the use of addictive substances is a way to fill time and experience other things that make you feel good. Think about things you enjoyed doing before you started using drugs - you may still like them. Dancing, running, bicycling, exploring the city, reading, meeting people, cooking and repairing things around the house are a few beginning ideas.
For some people, joining Alcoholics Anonymous (AA), Narcotics Anonymous (NA) or another support group is a way to spend time with others who are not drinking or using while building a spiritual program to help maintain sobriety. In general, if the people around you are supportive of your attempts to quit or cut down, the changes you make will be easier to maintain.
Some people find that getting into a treatment program is the easiest or the only way they can quit. Programs use different methods (methadone maintenance, aversion therapy, etc.) depending on the addiction and the philosophy of the program. Sometimes it takes a while to get into a program, so you may find that some of these other techniques will help you in the meantime. (Pregnant women have priority for getting into treatment.)
Relapse or "slipping" is a common experience for many people who try to quit or cut down on drinking or using. Rather than view this slip as a slide to doom, look at it as a detour that you can learn from. Relapse can be used to examine what and how certain thoughts, situations and cues may have led you to start using again, and you can choose to avoid these triggers in the future. Relapse can be an opportunity to renew your commitment to change, to seek further help and to remember your prior successes.
Regular exercise will help keep your body healthier and reduce anxiety, tension and depression. Exercise could include walking, jogging, cycling, swimming - even taking a leisurely stroll. Find an exercise that you enjoy and that gets your heart working, but doesn't leave you exhausted. Start with a 30-minute workout every other day, and gradually increase your time, but keep it under one hour. If you are feeling fatigued, getting sore muscles or have a poor appetite, try cutting your workout back. You're probably working too hard. Work up slowly - exercise should be fun.
If you get a cold or another infection, hold off on exercising until you feel better. Your body will need all its energy to recover. And make sure you eat enough calories to keep your weight up. Energy foods that are also high in vitamins and minerals include bread, potatoes, pasta and rice.
Fatigue is a very common symptom of HIV infection, and it has a variety of causes. Loss of energy and ambition are often part of the fatigue associated with AIDS, and sometimes it is difficult to know whether the tiredness is caused by the virus or depression. If you are feeling tired, pay attention to what your body is telling you and rest as much as possible. Let your friends or local agencies help you with the cooking, cleaning and child care, and try to find low-energy ways to have fun like playing board games or renting a movie. If the tiredness continues for more than a few days, be sure to tell your health care provider.
Taking Care While Traveling Internationally
Don't overexert yourself - get plenty of rest before, during and after your trip, especially if you travel to a different time zone and experience "jet lag." It is perfectly all right to take naps or spend an evening or day in your hotel room, even if you are in Paris. Save your energy for the things most important to you. If you tire easily, take taxis or public transportation and minimize the walking.
Try to avoid stress. This may be the toughest part of all, because traveling involves a change of surroundings and change is usually stressful. Remember that you are seeking change-expect it, and enjoy it. If you're a victim of pickpockets or some other petty crime, don't let it ruin the rest of your trip. It's out of your control. You can replace whatever was taken and get on with your life.
Will your medications be readily available in the countries where you will be traveling? If so, have your health care provider write out a generic prescription for each medication you will take with you, and carry these separately, just in case the medications are lost and you need a replacement. If not, be sure you have enough medication to get you through your trip. You may want to split them up so that if some are lost, you will have others stashed elsewhere.
Don't pack your pills into luggage to be checked aboard an aircraft - keep them on you in their original containers. It is true that in countries with HIV restrictions, this could be a giveaway to customs inspectors that you are HIV positive. However, if they are not in their original containers, they could be confused with illegal drugs by immigration officers. Also, make sure that antimalarial medication and antibiotics commonly used for traveler's diarrhea do not interact with other medications that you are using on a regular basis. Finally, plan ahead how you will keep medications refrigerated if this is required.
If you are traveling far, especially across multiple time zones, consider writing out a timetable for taking your medicines, starting in your current time zone and gradually (over several days) phasing in to your new time zone. Ask your provider or pharmacist to help you construct this table so that you keep taking the medications at their proper intervals: some need to be taken every 24 hours, some every 12 hours, some at 8 hour intervals, and so on. Once you have established your old routine in the new locale, you can carry on as usual, but you will need such a table for the return trip as well.
Some countries have policies that screen incoming travelers for HIV (especially those planning to stay for an extended period of time), and refuse entry to persons with HIV or AIDS.
If you are planning to visit a foreign country, you should be familiar with the policies and requirements of that particular country. Don't wait until you arrive to find out that you will not be allowed to enter the country. Information on visa policies is available from the local offices of the State Department and the consulates of the individual nations. We suggest you give them a call before making any solid travel plans. This information can be obtained anonymously or under a fake name.
Vaccines for Traveling
If you grew up in the United States or Western Europe, chances are you received many vaccinations for school. If you are going abroad, however, you may need to get other immunizations or update those you already have. In addition, there is now a vaccine for hepatitis-A, an illness that can result in serious diarrhea and is common in some countries. Because you are HIV positive, all of these vaccines are especially important.
However some vaccines, such as yellow fever, typhoid and poliomyelitis, contain live viruses that can be harmful to people who have weak immune systems. Talk to your health care provider or the travel clinic at the Health Department to find out about recommended vaccines.
Finally, see your health care provider when you return from your trip. If you develop any health problems after you have been home for a while, be sure to remind your provider of the trip.
Source: King County Public Health
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