"WE SUPPORT BECAUSE WE UNDERSTAND"

Living with HIV

While learning all you can about treatments for HIV/AIDS and Opportunistic Infections (OIs) is important, it is also important to learn about how HIV can disrupt our lives in less obvious ways.

How does it affect our mental health, and what can be done about this ? And should we be more concerned about our nutritional habits ?

In the language of clinical psychology, depression is a syndrome, a cluster of emotional, physical and behavioral symptoms characterized by sadness, low self esteem, loss of pleasure, and, sometimes, difficulty functioning. If these problems persist over a period of time, cause real suffering, and interfere with the business and pleasure of daily life, you may have a clinical depression.

In everyday conversation, people say they are depressed when they are feeling unhappy, down, blue, sad, or hopeless. Almost everyone has experienced these emotions, and if you have HIV disease, you may have reason to be anxious or depressed at times. These feelings are just one part of everyday life for most people.
However, if the feelings are overwhelming or persistent, you may benefit from psychological evaluation and treatment. Depression of this type can be effectively reduced or even eliminated with (often relatively simple) treatment. Professional intervention in serious depression can reduce suffering and improve the quality of life.
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.

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 coinfections : 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 in the last section, 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.

Nutrition & Diet Tips for People With HIV

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, & Nuts/Seeds Group and The Milk, Yogurt, & Cheese Group: It is recommended that most people consume at least 2-3 servings from each of these groups daily in order to get adequate protein, but some people will have to adjust this, based on individual needs.

Level 4 : The Fats, Oils, and Sweets Group: The less you consume of these, the better. Although a moderate amount of the good kinds of fats is healthy, keeping the overall fat content of the diet moderately low is important since researchers have shown that a high fat intake can be immunosuppressive, can cause diarrhea in HIV-positive people, and is tied to an increased risk of progression to cirrhosis in those with chronic hepatitis C. For those with elevated blood fats (caused by anti-HIV meds and/or lipodystrophy), a high-fat diet could also be risky to cardiovascular health.

It is also recommended that the "sweets" part of this group also be kept fairly low. No one would deny that the occasional sweet treat can be fun, but most sweets contain little in the way of nutrients, and often substitute for the healthier foods you might otherwise be eating. Limiting sweets is also important for anyone with elevated blood fats since a high sugar intake is tied to elevated triglycerides. By limiting the intake of sweets, you can improve your odds for cardiovascular health. For a more detailed overview of the fats, oils, and sweets group – including dietary tips for HIV-positive people – click here (note: this section is extensive!):

Nutrition & Diet Tips for People With HIV
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.

For a more detailed overview of the bread, cereal, rice, and pasta group – including dietary tips for HIV-positive people – click here :

More on Carbs (Bread, Cereal, Rice, & Pasta)

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.

For a more detailed overview of the vegetable group and the fruit group – including dietary tips for HIV-positive people – click here :

More on Vegetables & Fruits

Level 3 : The Meat, Poultry, Fish, Dry Beans, Eggs, & Nuts/Seeds Group and The Milk, Yogurt, & Cheese Group: It is recommended that most people consume at least 2-3 servings from each of these groups daily in order to get adequate protein, but some people will have to adjust this, based on individual needs.

For a more detailed overview of this group – including ways to adjust the amount of protein you eat – click here :

More on Protein-Rich Foods

Level 4 : The Fats, Oils, and Sweets Group: The less you consume of these, the better. Although a moderate amount of the good kinds of fats is healthy, keeping the overall fat content of the diet moderately low is important since researchers have shown that a high fat intake can be immunosuppressive, can cause diarrhea in HIV-positive people, and is tied to an increased risk of progression to cirrhosis in those with chronic hepatitis C. For those with elevated blood fats (caused by anti-HIV meds and/or lipodystrophy), a high-fat diet could also be risky to cardiovascular health.

It is also recommended that the "sweets" part of this group also be kept fairly low. No one would deny that the occasional sweet treat can be fun, but most sweets contain little in the way of nutrients, and often substitute for the healthier foods you might otherwise be eating. Limiting sweets is also important for anyone with elevated blood fats since a high sugar intake is tied to elevated triglycerides. By limiting the intake of sweets, you can improve your odds for cardiovascular health. For a more detailed overview of the fats, oils, and sweets group – including dietary tips for HIV-positive people – click here (note: this section is extensive ! ) :

More on Fats, Oils, and Sweets

Remember Variety and Color : Each food has its particular strengths and weaknesses in terms of nutrient content so choosing from a wide variety of foods at each pyramid level will help ensure intake of all the nutrients nature can provide, rather than the more limited number that might result from repeating the same foods over and over. And emphasizing color when you select that wide variety of foods is nutritional insurance. Call it the Rainbow Theory of Shopping. When you're in the bread, pasta, cereal, and cracker aisles, choose brown, whole-grain varieties instead of white to get all the nutrients that over-refining removes. And when you're in the produce section, grab red and purple and green and orange and yellow and blue because that's where the nutrition is. Any time you see natural color, you're seeing nutrients. The more your shopping basket looks like a rainbow of color, the better off your diet will be.