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 The
importance of good nutrition for people living with HIV/AIDS has long
been recognised. However, the past few years has seen a growing interest
amongst positive individuals and peer support groups in the improved quality
of life derived from diet, supplements and exercise. In view of this interest
Positive Lives presents the following comprehensive summary from the American
Community Research Initiative Forum
Benefits
of Diet, Supplements & Exercise in HIV Care CRIA Community Forum Summary
- July 2000 By Anne Monroe
We all know that we should eat right and exercise, but turning knowledge
into action requires energy, time, and support. The benefits of good nutrition
and exercise are well worth the effort, however, especially for people
living with HIV. At the July community forum, Jan Zimmerman, a nutritionist
at the Village Centre for Care AIDS Day Treatment Program, and Sean Crawford,
a clinical exercise specialist, shared valuable information about the
ways in which diet, supplements, and exercise contribute to overall health
and HIV treatment..
Nutrition
and HIV
In her presentation entitled "Building Health & Healing with HIV/AIDS,"
Jan Zimmerman provided practical advice about food and supplement choices.
These choices are just one part of healthy living, however. Ms. Zimmerman
views emotional and spiritual health as the foundation for health and
healing. You can use support groups, conversations with friends, meditation,
or church, among other resources, to support your emotional and spiritual
health, but your emotional health must be well established before you
undertake healing nutrition and exercise. The final component of health
and healing, especially in HIV disease, is medication and side effect
management. These three elements of health and healing must be practiced
daily.
HIV nutrition specialists can help you do more than just gain or lose
weight.
They can provide guidance on both HIV-related and medication-related ailments,
including appetite loss, bloating/gas, diarrhea, kidney disease, lipodystrophy,
and wasting. Some of these conditions can be treated without pharmaceutical
interventions.
Ms. Zimmerman explained the general principles of Nutritional Healing
in HIV/AIDS upon which she bases her practice:
- Maintain normal
body weight. Be aware of the caloric intake you need to achieve and
maintain a normal weight.
- Build muscles/maintain
lean body mass (avoid wasting). Use strength training and, if necessary,
steroids or hormones to build/maintain muscle mass.
- Optimize digestion.
The digestive tract is your center of health - simple steps like chewing
your food carefully can make its job much easier! Eating 4-6 small meals
is more efficient than eating 1-3 large meals.
- Eat more "healing
foods", fewer processed foods.
- Drink 6-10 cups
of non-caffeinated fluids daily.
- Use supplements
rationally and consistently.
- Address social
and emotional isolation, as these factors can negatively influence your
food choices.
Foods that Heal
Following a "healing foods" diet involves choosing foods that have a positive
influence on your health. The benefits of a healing foods diet include
increased energy level and a healthier heart. A healing foods diet is
not about deprivation, but instead focuses on harm reduction and moderation.
To get started, follow these guidelines:
EAT:
PROTEIN (at least 3-6 servings per day) Lean meats, fish, poultry
(no skin), low fat dairy products, beans, nuts, seeds, soy products Tip:
Try walnut butter - grind walnuts in a blender with a touch of olive oil
for a high-protein treat.
CARBS (at least 5 servings per day. Whole grains (oatmeal, high-fiber
cereal, barley, whole wheat bread) Tip: High-fiber cereal should have
at least 5 grams of fiber per serving - check the box!
FRUITS AND VEGETABLES (5 servings per day) All fresh, frozen, and
dried fruits and vegetables Tip: Make shakes to get your day's fruit into
one glass.
FATS (1-2 servings per day) "Cold-pressed" olive, canola, and sunflower
oil, "trans-free" margarine, cold water fish (salmon, sardines, mackerel),
avocados Tip: Promise brand "trans-free" margarine is Jan's pick for a
butter substitute.
CALCIUM-RICH FOODS (3 servings per day or a supplement) Low fat
dairy products, calcium-enriched juice Tip: Chomp on Tums for calcium
if you have a hard time getting enough in your diet.
AVOID:
HIGH-FAT PROTEIN (max 2-3 servings per week) Fatty meats (hamburger,
hot dogs, bacon, sausage), fried chicken, high-fat dairy products (whole
milk, cheese, ice cream)
HIGH-FAT CARBS (max 2-3 servings per week) Refined sugars (cakes,
cookies, candy, soda, and sugary cereal), white flour (doughnuts and pastry),
French fries
FATS (as little as possible) Butter, cream, lard, Crisco. Try to
drink less coffee, tea, cola, and to avoid excessive beer, wine, or liquor
consumption. All of these beverages contribute to dehydration.
The Story on Supplements
Supplements
can be beneficial as just that: supplements to a well balanced healing
foods diet .Supplements are not a substitute for the vitamins in food.
If you'd like to start taking supplements, consult with an HIV nutrition
specialist to help you develop a supplement regimen that meets your needs.
In general:
a)Use supplements consistently for 6-8 weeks in order to see results.
b)Never take supplements on an empty stomach: they will be absorbed more
effectively if you take them with food.
c)Tell your primary care provider about the supplements that you are taking.
Some specific supplement
suggestions are:
PROTEIN/CALORIE (Boost, Ensure, etc.)
Use: weight gain *not for people with severe thrush or
yeast infections
PROTEIN POWDERS (whey, glutamine, soy)
Use: increase protein intake (can help build/preserve muscle mass)
*not for people with severe liver or kidney disease
THERAPEUTIC MULTIVITAMINS
Use: provides 100% of the recommended daily allowance of many vitamins
SELENIUM
Use: antioxidant
This is the only supplement directly related to improved mortality in
HIV infection. The recommended daily allowance can be obtained in 1-2
Brazil nuts or in pill form.
ALPHA LIPOIC/THIOCTIC ACID
Use: antioxidant
Good for liver detoxification and neuropathy relief.
CALCIUM
Use: preserves bone, muscle, and nerve function
May help treat diarrhea.
COENZYME Q10
Use: support body's energy pathways
May aid in mitochondrial toxicity from long-term antiretroviral use.
For further information on nutrition's role in HIV care, Ms. Zimmerman
recommends reading “Healing HIV: How to Rebuild Your Immune System” by
Jon Kaiser and “Nutrition and HIV: A New Model for Treatment” by Mary
Romeyn.
The Fitness Contribution
The other component of healthy living is physical fitness. In his presentation,
Sean Crawford described the three components of fitness: flexibility,
strength, and cardiovascular conditioning. Increased flexibility can be
attained through stretching, yoga, or tai chi, or even just touching your
toes every morning! Weight lifting, body weight exercises (such as pull-ups
and sit-ups), and calisthenics (such as squats, crunches, and lunges)
are activities commonly used to develop strength. Cardiovascular conditioning
is participating in activities that push you above and beyond your activity
of daily living. These activities may include walking, running, biking,
swimming - anything that gets your heart rate up and that you enjoy. All
three components of fitness are important. But for people with HIV, especially
those who are wasting, strength training to build and maintain muscle
is the most valuable activity.
Strength training can also: Improve immune function. Increase appetite.
Increase metabolism. Increase bone density. Increase functionality (allow
you to perform physical tasks with greater ease)
Have you been thinking about starting an exercise program? According to
Mr. Crawford, you're in the contemplation stage of developing a lifelong
exercise regimen. Good for you! This is the first step. There are plenty
of people who haven't made it that far, and may never incorporate exercise
into their lives. Your next task is preparation - gathering the equipment
you will need to participate in an exercise regimen. This could include
a good pair of running shoes, a gym membership, a new soccer ball or tennis
racket, some hand weights, or a pair of Roller blades. Whatever you choose,
remember that it will be easier to stick with an exercise regimen if you
actually enjoy what you're doing.
Now, take action!
You should start with 20 to 30 minutes of aerobic activity three to four
times a week. You can increase this amount as you get stronger, but you
should always factor in some time for your muscles to rest.
Maintaining a regimen year-round can be even more challenging that beginning
to exercise in the first place. Try to stick with it! If you relapse into
a period without exercise, start again as soon as you can. It will help
to set both long- and short-term fitness goals for yourself and to reward
yourself when you reach those goals.
If you're beginning a strength-training regimen that includes weights
and/or equipment, supervised instruction is a must, particularly at first.
This can mean taking classes or a trainer to help you work out a safe
and helpful regimen.
A Final Note
As you start to incorporate nutrition and fitness into your life, remember
that small changes, such as switching from whole milk to skim milk or
walking 10 blocks instead of taking the bus, can make a difference. If
these small changes become lifelong good habits, you will enjoy better
overall health while living with HIV.
©
CRIA. The Community Research Initiative on AIDS (CRIA) is a non-profit
community-based AIDS research and treatment education center. In conjunction
with recognized leaders in AIDS research and treatment, primary-care physicians,
and people living with HIV disease
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