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Healthy Diet and Nutrition in HIV

Updated on March 10, 2021
Medically reviewed by
Barry S. Zingman, M.D.
Article written by
Paz Etcheverry, Ph.D.

Good nutrition plays an important role in maintaining your quality of life and supporting your health and well-being when you are living with HIV. Being well-nourished may help you better withstand opportunistic infections and disease progression, thanks to a strengthened immune system.

If you have already started your antiretroviral therapy (ART), you may have noticed weight gain, especially in the abdomen — a common side effect of ART. ART is essential to HIV treatment, but particularly older treatments could lead to side effects, including an increased risk of cardiovascular disease, diabetes, bone loss, and kidney disorders. Healthy eating patterns, however, might help reduce the chances of these side effects, making your diet an important part of disease management.

Overall, a healthy, balanced diet that incorporates fruits and vegetables, whole grains, low-fat or nonfat dairy products, and a variety of proteins can help support a healthy weight and reduce instances of illness or infection. An HIV-healthy diet should also be low in sodium, saturated and trans fats, and added sugars.

Eating well is often easier said than done, however. Healthy, whole foods may be hard to come by in some areas. Moreover, the expense of fresh foods may steer you toward processed foods instead. However, finding ways to make a healthy diet more accessible or affordable — such as choosing produce that’s in season — may help you bring these nourishing foods into your daily meals more often. Eating some whole foods is better than none, so start where you can.

Although many healthy-diet recommendations are typical for anyone, regardless of health conditions, there are a few considerations specific to the needs of those living with HIV. For example, people living with HIV are found to commonly be vitamin D-deficient. Vitamin D deficiency is associated with increased inflammation and negatively impacts bone health.

Other nutrients of interest, due to their potential role in immune function, include:

  • Zinc
  • Selenium
  • B vitamins
  • Vitamin C
  • Vitamin E
  • Vitamin A

With all that in mind, here are recommendations for what to eat more of, what to limit, and what else to think about as you fill your plate. Remember to confer with your health care provider before starting a new diet or supplement.

Proteins and Omega-3 Fatty Acids

Proteins serve many important functions, including providing you with energy. The proteins you consume contribute to cell growth, maintenance, and repair. They are also integral in transporting nutrients to different parts of your body and building a strong immune system via the production of antibodies. If we do not consume enough amino acids, the building blocks of proteins, we lose our ability to make the proteins that we need.

According to a 2019 study in the Journal of Nutrition, people living with HIV tend to consume less seafood and plant proteins and fewer beneficial fatty acids than people without HIV. It’s important to find ways to build protein into your diet. The goal is to consume at least 5 to 6.5 ounces of protein per day.

Lean cuts of meats are good choices for animal protein sources. Fish such as herring, mackerel, salmon, sardines, and tuna contain omega-3 fatty acids. Omega-3 fatty acids play an important role in managing inflammation and protecting against cardiovascular diseases.

Other sources of omega-3 fatty acids include:

  • Canola oil
  • Chia seeds
  • Flaxseed (including oil)
  • Fortified milks
  • Olive oil
  • Soybean oil
  • Walnuts

For less expensive or plant-based options, try legumes such as:

  • Black-eyed peas
  • Chickpeas
  • Fava beans
  • Kidney beans
  • Lentils
  • Pinto beans
  • Soybeans

These are great sources of protein that are high in minerals and vitamins and nearly free of saturated fat, as well as cholesterol.

Fruits and Vegetables

Fruits and vegetables are sources of dietary fiber, which make you feel fuller and help you avoid overeating. Furthermore, fruits and vegetables provide minerals, such as magnesium and potassium, which are good for the management of blood pressure (a concern in people with HIV). They also contain antioxidants such as beta-carotene and vitamins E and C, which may have beneficial health effects.

Try to consume 1 to 2 cups of fruits and 1 to 3 cups of vegetables per day. It may sound like a lot, but try a few tips that may make it easier. When filling your plate, shoot to fill half of it with fruits, vegetables, or a combination of both. And when you can, make your plate as colorful as possible, incorporating all colors of the rainbow:

  • Yellow — Bananas, corn, pineapple, summer squash, and yellow bell peppers
  • Orange — Apricots, cantaloupe, carrots, grapefruit, oranges, orange bell peppers, papaya, and pumpkin
  • Red — Apples, bell peppers, cherries, cranberries, raspberries, strawberries, and tomatoes
  • Green — Brussels sprouts, broccoli, celery, cucumber, green bell peppers, lettuce, kale, and zucchini
  • Blue, purple, and black — Black currants, blackberries, blueberries, eggplant, elderberry, concord grapes, and plums
  • White, tan, and brown — Cauliflower, mushrooms, onions, potatoes, sweet potatoes

Whole Grains

Whole grains contain dietary fiber, several B vitamins, and minerals, especially iron, magnesium, and selenium. Refined grains, on the other hand, (which include degermed cornmeal, white bread, white flour, and white rice) have been stripped of the healthy vitamins, minerals, and dietary fiber in the bran and germ of the grain.

Whole grains also have a lower glycemic index than refined grains, which means that they prevent fluctuations in your blood sugar and insulin levels. With more stable blood sugar, you are likely to eat less and achieve a healthy weight.

It’s recommended to incorporate at least 3 to 8 ounces of whole grains in your meals every day. To eat more whole grains, choose:

  • Brown rice
  • Oatmeal
  • Whole-wheat bread, pasta, or crackers
  • Popcorn (healthiest with little or no added salt and butter)

If they’re available to you, experiment in your kitchen with other whole-grain options, including barley, buckwheat, bulgur (cracked wheat), or millet.

Low-Fat or Nonfat Dairy Products

As part of a healthy diet with HIV, choose low-fat or nonfat dairy products, which have no or lower levels of cholesterol and saturated fats than the whole versions. Milk and yogurt have more potassium and less sodium than most cheeses, so they may be better options. Aim for 3 cups of low-fat or nonfat dairy products per day.

Some people are unable to eat dairy. If you have a milk allergy or sensitivity such as lactose intolerance, or if you have an interest in a plant-based diet, nondairy milk alternatives or lactase supplements may be options for you. Nondairy alternatives to cow’s milk include:

  • Almond
  • Cashew
  • Coconut
  • Flaxseed
  • Hazelnut
  • Hemp
  • Oat
  • Rice
  • Soybean

When considering nondairy milk, take note of the labels. Many are sweetened. It may be better to choose unsweetened versions of milk alternatives to avoid the added sugars. Also, some are fortified with calcium and vitamin D. Lactase supplements come in pills or drops and are sometimes already incorporated into certain brands of milk.

What To Limit in an HIV-Healthy Diet

An HIV-healthy diet should also be low in sodium, saturated and trans fats, and added sugars.

Sodium

Having a lot of sodium in your diet may increase blood pressure, a major risk factor for heart disease and stroke. Try to consume less than 2,300 milligrams of sodium per day by:

  • Buying fresh, frozen, or canned vegetables with no salt added
  • Choosing food products labeled “low sodium,” “reduced sodium,” or “no salt added”
  • Selecting fresh meats as opposed to cured, salted, or smoked varieties

The Centers for Disease Control and Prevention have other helpful tips on how to reduce your sodium intake.

Saturated and Trans Fats

Of all the dietary fat people consume, saturated fats and trans fats are the most highly correlated with an increased risk of cardiovascular diseases, because both increase LDL (bad) cholesterol. Trans fats also reduce HDL (good) cholesterol.

Saturated fats are found in:

  • Beef
  • Butter
  • Coconut oil
  • Cream
  • Lard
  • Palm kernel oil
  • Several types of cheese
  • Whole milk

Trans fats are present in processed foods, such as:

  • Coffee creamers
  • Desserts
  • Frozen pizza
  • Margarine
  • Packaged snack foods

Experts suggest limiting the calories from saturated fats to less than 10 percent of your total calories each day and limiting trans-fat consumption as much as possible.

Added Sugars

Added sugars are syrups, sugars, or caloric sweeteners that are added to foods and beverages such as soft drinks and sweetened fruit juices. Added sugars do not include those carbohydrates naturally present in dairy and fruit or unsweetened fruit juice.

Limit your intake of added sugars to less than 10 percent of your total daily calories. Some studies have shown that these sugars may depress your immune function and mood and increase your risk of obesity, diabetes, and cardiovascular diseases.

Don’t Forget To Drink Water

Drinking enough water is vital when you have HIV. Water transports nutrients to and from cells. Water has other benefits for those with HIV, as it:

  • Reduces the side effects of medications
  • Flushes out the medicines that have already been used by your body
  • Cools you off when your body temperature rises due to exercise, illness, or warm weather
  • Helps you avoid dehydration and constipation

Try to consume at least eight to 10 glasses of water (or other fluids including juices or soups) a day. Drink more if you’re physically active. If you are finding it hard to remember to consume water throughout the day, downloading a hydration app on your phone may help. It alerts you when you should be drinking more water and identifies the volume of water that you should consume daily based on your weight and gender.

Other Diet-Related Considerations While on ART

Foodborne illnesses can pose a serious threat to people with HIV. Therefore, make sure that you do not consume the following:

  • Raw or undercooked meat, poultry, and seafood
  • Raw eggs or foods that contain raw eggs
  • Unpasteurized fruit juices, dairy products, and milk

To reduce your risk of foodborne illnesses, always follow food safety practices when preparing, serving, and storing foods.

You may also want to avoid certain supplements. Although some herbs and plant botanicals, such as milk thistle and red yeast rice, have been touted as beneficial, they may potentially interact with certain antiretroviral drugs. Therefore, always consult with your health care provider before supplementing with herbs.

Talk With Others Who Understand

Changing your diet can be a challenging undertaking. Finding the motivation to eat right when you have HIV is best done alongside others who understand the obstacles and rewards. Connect with otters who understand life with HIV through myHIVteam, the social network for people with HIV and their loved ones. Here, more than 29,000 members come together to ask questions, give advice, and share their stories.

Are you making changes to your diet for healthier living? What challenges have you faced, and what’s made it easier? Share your experience in the comments below, or start a conversation by posting on myHIVteam.

References
  1. Position of the American Dietetic Association: Nutrition Intervention and Human Immunodeficiency Virus Infection — Journal of the Academy of Nutrition and Dietetics
  2. HIV and Nutrition and Food Safety — National Institutes of Health
  3. Common and/or Severe Adverse Effects Associated with Antiretroviral Therapy — National Institutes of Health
  4. Diet Quality Is Low and Differs by Sex in People with HIV — The Journal of Nutrition
  5. Dietary Guidelines for Americans 2020–2025 — U.S. Department of Agriculture
  6. Diet and Exercise for HIV-Positive Individuals — University of California San Diego Health
  7. Effects of Vitamin D Supplementation on Bone Mineral Density and Bone Markers in HIV-infected Youth — Journal of Acquired Immune Deficiency Syndromes
  8. Inflammation and Vitamin D: The Infection Connection — Inflammation Research
  9. Vitamin D Deficiency — StatPearls Publishing
  10. Important Nutrients to Know: Proteins, Carbohydrates, and Fats — National Institute on Aging
  11. Dietary Protein Intake and Human Health — Food & Function
  12. What Foods Are in the Protein Foods Group? — MyPlate
  13. Omega-3 Fatty Acids — National Institutes of Health
  14. Might a Vegan Diet Be Healthy, or Even Healthier? — Animal (De)liberation: Should the Consumption of Animal Products Be Banned?
  15. Legumes: Health Benefits and Culinary Approaches To Increase Intake — Clinical Diabetes
  16. Health Benefits of Dietary Fiber — Nutrition Reviews
  17. Health Benefits of Fruits and Vegetables — Advances in Nutrition
  18. What Foods are in the Fruit Group? — MyPlate
  19. What Foods Are in the Vegetable Group? — MyPlate
  20. Processed Foods: Contributions to Nutrition — American Journal of Clinical Nutrition
  21. What Foods Are in the Grains Group? — MyPlate
  22. Glycemic Index and Glycemic Load — Oregon State University
  23. What Foods Are in the Dairy Group? — MyPlate
  24. Sodium — Centers for Disease Control and Prevention
  25. How to Reduce Sodium — Centers for Disease Control and Prevention
  26. Saturated Fatty Acids and Cardiovascular Disease: Replacements for Saturated Fat To Reduce Cardiovascular Risk — Healthcare
  27. Trans Fatty Acids — A Risk Factor for Cardiovascular Disease — Pakistan Journal of Medical Sciences
  28. Cut Down on Saturated Fats — Office of Disease Prevention and Health Promotion
  29. Added sugars: Definition and Estimation in the USDA Food Patterns Equivalents Databases — Journal of Food Composition and Analysis
  30. 2015-2020 Dietary Guidelines — Office of Disease Prevention and Health Promotion
  31. Effects of Sugar, Salt and Distilled Water on White Blood Cells and Platelet Cells — Journal of Tumor
  32. The Depressogenic Potential of Added Dietary Sugars — Medical Hypotheses
  33. Relationship between Added Sugars Consumption and Chronic Disease Risk Factors: Current Understanding — Nutrients
  34. How Much Water Do I Need? — U.S. Department of Veteran Affairs
  35. The Core Four Practices — Partnership for Food Safety Education
  36. Adipose Tissue as a Site of Toxin Accumulation — Comprehensive Physiology
  37. Water, Hydration, and Health — Nutrition Reviews
  38. Effects of Sunlight Exposure and Vitamin D Supplementation on HIV Patients — The Journal of Steroid Biochemistry and Molecular Biology
  39. Effect of Milk Thistle on the Pharmacokinetics of Darunavir-Ritonavir in HIV-Infected Patients — Antimicrobial Agents and Chemotherapy
  40. Red Yeast Rice — National Center for Complementary and Integrative Health
Barry S. Zingman, M.D. specializes in HIV/AIDS medicine and general infectious disease. Review provided by VeriMed Healthcare Network. Learn more about him here.
Paz Etcheverry, Ph.D. has an M.S. in food science and nutrition from North Carolina State University and a Ph.D. in food science and technology from Cornell University. Learn more about her here.

A myHIVteam Member said:

Very informative. I've made changes and I Always consult with my primary physician first. Now sticking with this cpap. Machine drives me crazy but my daughter in law who's a RN has advised me to start… read more

posted about 1 month ago

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