Being Alive 1996 Sep 5: 1
It seems so simple: What's the best diet for people living with
hiv/aids? I'm asked that question a lot, and I tend to give
answers that start the same way: It depends. Depends on
what?-that's the real question.
The Bathroom Answer
If you are hiv+ and have diarrhea, your best diet is one that
contains no fruits, vegetables, whole grains or other
"roughage," which can promote diarrhea. We can lose a lot of
the nutrition value of healthy food if it just ends up in the
toilet. It would probably be easier to just scrape the health
food off of the plate directly into the toilet and not make the
intestines work at processing it first! On the other hand, if
you are hiv+ and don't have diarrhea, the same foods-fruits,
vegetables and whole grains-are among your best food choices.
So, it depends.
The Protein Answer
Then there is protein, representing one of the most important
differences between hiv-negative and hiv+ people. People lucky
enough to be hiv-negative need lower amounts of protein than
most people realize. Excess protein is not discarded by the
body; it makes a lot of excess work for the liver and kidneys,
just to ditch the surplus. As a rough estimate, negative people
probably require about 60 grams per day. Positive people can
require up to three times that amount-often as high as one gram
per pound of body weight, up to 180 grams per day. Your own
individual level can best be determined with the help of a
nutritionist/dietitian specializing in hiv/aids healthcare.
A person living with HIV/AIDS may have problems secondary to
just plain old hiv. There's always a threat of liver
malfunction resulting from the use of old stand-by hiv meds.
And now there's the added risk of kidney malfunction caused by
protease inhibitors and other new poly-drug cocktails. So it's
important to protect vital organs as well as to get adequate,
but not too much protein. It's far beyond casual kitchen
science-no longer do-it-yourself-work. Too much protein can be
a hazard for these organs, and inadequate protein can deplete
overall immune function. Again, it depends.
The Fat Answer
Often weight gain is desirable. For adding pounds quickly
there's nothing more effective than eating high-fat food. This
is not to suggest that these foods are always the best
nutrition choices, but if fast calories are what you need, fat
food will do it fastest. Can you tolerate a high-fat diet? For
this answer, we must look to the health of your fat-processing
organs: The liver (liver function tests), and the pancreas
(amylase and lipase tests). Then, there's the intestines-are
you malabsorbing fat? For that answer, look to your
toilet-before flushing. If you have slippery poop that smells
bad and leaves a soapy or slimy layer at the top of the water,
you probably can't tolerate too much fat; now you're in the
Most people don't know how to dose fat correctly; most hiv/aids
nutritionists do, so seek professional advice. Your own best
fat level depends on many variables.
Is eating fat a healthy thing to do? Well, not usually. Will
the fat you eat turn into the fat you wear? It depends; it's a
matter of calories. The source of calories has nothing to do
with their ability to become body fat. Let me explain: We all
need a certain number of daily calories for basic energy.
Calories are, in truth, just units of energy. If you spend
(use) your energy wisely, like exercising, and you don't
consume more calories than you actually spend, you won't gain
body fat. If you take in too many calories for your daily
workload, that energy will probably be deposited on your body
as flab fat.
So, the source of the calories has little to do with body fat.
The source is everything as to whether calories are "empty"
calories. Fat calories are usually empty. A donut, for example,
has as many calories as a chicken breast. Each of these foods
contributes calories, which are units of energy. And if either
one gives you more calories than you need, those calories will
become body fat. On the other hand, if you actually need this
calorie level, body fat won't happen-the calories will be used
to meet basic energy needs. Calories and energy; they're
If appetite doesn't happen and you slide into skinny, then add
calories to your diet. If you can't seem to eat enough to gain
weight, then a fat fix may be a good boost for you, especially
if all you need is calories. There is often no nutrient value
in food fat. Butter is nutrient free; it's all fat. (Butter is
also my favorite food.) If you're at your goal weight, butter
can add unwanted pounds. If you're too thin, butter can add
desired pounds. It's better to be at your desired weight than
to get too thin. Try to eat good-food fat, like avocadoes. They
have the same amount of fat as butter, but there are powerful
nutrients in avocadoes! Nuts and seeds also fall in the
fat-with-nutrients food group. So, have it all; eat enough
calories to maintain your own personal best weight. Exercise to
make sure you turn extra calories into muscle.
So, food fat may become body fat, or it may become desired
added weight, as muscle, when used with the exercise method; it
The Exercise Answer
Do you work out? If you don't, and you find yourself with a
little too much "extra" then heed that wake-up call; tone the
tummy. If you're too thin, it's time to add weight and buff up.
I can't tell you what a miraculous feeling it is to work out
and gain muscle. It takes time, but good planning can help. It
may actually save time because you may require less sleep than
when you were a slug. (No offense intended; I personally am a
former slug-we've all gotta start somewhere!) Since muscle is
packaged in our bodies along with water, then the water weight
will do two things: it will make you weigh more, and it will
improve your hydration status.
The Water Answer
Over the many years I've worked in hiv-based nutrition, one
thing I've seen is too much dehydration. This is, on its own,
an invitation to visit your local neighborhood hospital for a
rehydration infusion. If you drink the wrong water, it could be
an invitation to that same hospital for diarrhea control.
Remember, I'm the one nagging hiv-land about drinking only
"safe water" and I regret to say that I'm still not getting my
message out in the meaningful way it takes to get people to
change their behavior.
I've been doing some water research. As you probably know, in
1993 Milwaukee had a cryptosporidium outbreak. This crisis
caused diarrheal illness in over 450,000 residents, sent 11,000
to the hospital, and claimed the lives of more than 100
victims. Since then, there have been water problems in
Washington D.C., where water supplies were stalled for several
24-hour episodes, and once in New York where residents were
told to drink only bottled water for several days. Crypto is a
very very teeny tiny little creature that swims in chlorine
bleach, multiplies two-for-one in iodine, and is killed-dead-by
heat (145 degrees).
Municipalities, especially Milwaukee, are using ultra micro
filtration, ozone treatments, and ionizations to clean up the
water messes. Will the water scares go away? Absolutely not; if
anything, they'll become more common. Nature makes it happen:
Animal dung contaminates high-ground springs and surface soil.
Rain and gravity bring the dung remnants to lower ground where
contributions are made by other, often different species. Then
downhill again, then-etc. Will animal dung get any cleaner?
Will animals restrict their movements to port-a-potties? Yes!
When pigs fly!
Is your bottle of water safe? Does it really come from where
the label says it does? Is the answer to these questions
"maybe"? Then here are the facts: Bottled water is only
required to meet municipal (tap water) standards. About 20% of
tap water can be contaminated. Logic is wonderful: Bottled
water has to be 80% good and can be 20% bad! Is this risk OK
What can you do to protect yourself? At home, it's easy. Drink
bottled, distilled water. Distilled water is really just
captured steam, so that tells you it's already been
heat-treated; so much for crypto. You can carry your water
wherever you go. But what about ice? What about sodas in
restaurants, movie theaters, bars, etc.? How's their ice? How
neurotic is too neurotic? Remember, a hospital is not a
germ-free environment; and besides, it's not healthy to drink
their water either. Suppose the new "compassionate use" crypto
drug (NTZ) really works; do you want to take it?
But, what to do when not at home? Like at a restaurant. Order
canned beverages like tomato juice, fresh-squeezed orange juice
(not from concentrate), milk, beer, wine or coffee/hot tea.
Remember, all the extra things you do to avoid drinking tainted
water-you'll never know if it prevented crypto or not. But you
will know if unsafe water gets you! And it is not worth finding
out on your own. You can always bring your own beverage-to
restaurants, theaters and sports events. At least, I've never
been busted for this. Back to dehydration: I often suggest
eating foods high in salt because it makes you thirsty. Then
you drink. Safe water. Then the salt helps your body hold onto
the fluids you give it. But some people really shouldn't eat
too much salt for a variety of reasons. Again, this isn't
do-it-yourself nutrition-it depends! Get professional advice
prior to avid salt-eating.
The Garlic Answer
There are medicinal foods-they act as immune potentiators.
Garlic is one. I'm often asked about taking garlic pills. Even
"odorless" garlic may cause that "fragrance," leaving you all
alone and highly unpopular in close spaces like elevators. If
you're going to stink anyway, why not just eat the garlic? It's
cheaper for sure. Baking garlic "bunches" can also be a lot of
fun! But if you have indigestion, garlic and other spicy foods
may be hard to take and the pills may then be a better choice.
So even the wisdom of eating medicinal foods like garlic can
depend on a lot of other factors. Never be too far away from
your Breath Assure!
The Fish Oil Answer
Another medicinal food part is fish oil from high-fat fish like
tuna and salmon (well-cooked please!). Fish oils have been
showing immunological promise for over a decade and you can buy
oil pills everywhere. They're much more expensive than the
original fish-way more! And remember garlic breath? Wait till
your friends sniff out your fish oil pills! Eat the fish, ditch
the pills. Spend some of that old pill money for real fish when
Never one to miss an opportunity to mention food safety-fish
oils can thin the blood. Pills are more concentrated; they can
make blood really thin. Often this is good, but importantly,
often it is not. Your own bleeding time is important here, and
simple medical tests can provide the best information on your
own bleeding time. So, fish may be both a medicinal food and
also could cause harm. Ask your doctor. After all, it depends!
The Dairy Answer
Now here's a hot, controversial nutrition topic. According to
folk wisdom, either you shouldn't use dairy products or you
should. When folk wisdom gets really prohibitive or absolute,
that unbending "wisdom" isn't an "It Depends" type of approach.
Dairy can often produce serious allergies or reactions. If
dairy does not cause problems for you, using these foods (milk,
cheese, yogurt) allows more freedom for your overall nutrition
program. High in both protein and calcium, dairy products offer
seriously good nutritional benefits. Since nutritionists
disagree, decide for yourself-if you have a choice.
The Supplement Answer
For vitamin and mineral supplementation, advice may depend more
on your advisor than on your condition. I've "come out" on this
subject before and nothing's happened to make me change my mind
or alter my advice. My recommendations are always based upon
the circumstances of a given person at a given time. That's why
I don't give specific numbers for the various nutrients. My
general advice agrees with that of even the most avid critics
of supplementation: it is recommended-if only at RDA levels.
But we all disagree on the particulars: which nutrients and in
what amounts you should take. If you're working with a
nutritionist who recommends RDA levels of supplements, my
advice is to get a "second opinion."
The Individual Comment
The nutrition answers I've suggested here point out the need to
know answers about you, the individual. Who are you, how are
you doing, and what, when and how do you eat? Speaking of
individuals, that's exactly what we all are. And that's what
makes hiv/aids nutrition such a specialized area of healthcare.
Remarkably, there seems to be almost 100% agreement that we are
all individuals! That means that no two people are alike. No
wonder the individual answers depend on you!
First do no harm. Should the advice in this column be, or seem
to be related to any adverse consequences, check with your
doctor and/or nutritionist. It does matter!
(Jennifer Jensen, MS, RD, CNSD is in private practice. She
offers a sliding scale fee arrangement for hiv/aids clients.
Supplements are provided at cost. She always welcomes your call
at 310.450.5581, or send e-mail to NutPower@aol.com.)