Gordon Fleming is already planning his garden this year. He dreams of beets, beans, carrots, yellow tomatoes and zucchini. Fleming is careful about what he eats, and if you see him at the grocery store he’s probably reading labels.
Good nutrition means something to this 35-year-old Spokane man, who was diagnosed 10 years ago with human immunodeficiency virus (HIV).
“I eat significantly better than when I was diagnosed,” says Fleming, whose health is still good. “I try to get organic food when I can. I like growing my own stuff in the garden.”
Nutrition is one of the strongest defenses against immune system diseases such as HIV and AIDS. People who have the virus must get adequate nutrients, avoid severe weight loss, monitor the interaction between their food and medications and carefully follow food safety rules.
Joe Tomlinson, director of prevention and outreach at Spokane AIDS Network, says there are about 400 reported cases of people with HIV and 300 more with full-blown AIDS in the Spokane area. However, the actual totals are estimated to be 10 times that.
Good nutrition, Tomlinson says, is “absolutely vital.”
While low-fat diets are recommended for healthy people, those with immune diseases typically need more calories and protein.
“When I’m working, I usually eat five meals a day, but two of them are smaller,” says Fleming, a computer programmer. He likes a big breakfast, a fairly good-sized lunch, two fruit snacks during the day and a large dinner in the evening.
“People with HIV should eat from all the food groups,” says Christopher Lawrence, a health counselor with the Life Balances program in Spokane. “They should eat lots of food.”
Lawrence, a former vegetarian, now advocates a diet that includes red meat and dairy products. “If you’re going to build a body, you need to use what a body is built from,” he says.
Lawrence’s partner, who has AIDS, has built his weight back up through Life Balances, a health program that uses blood tests to determine nutritional imbalances.
When working with HIV patients, dietitians do more than just talk about the food pyramid.
“We find out what they’re eating and show them ways to increase their caloric intake,” says Annie Frederick, a dietitian with a Spokane home health care company who has volunteered with the AIDS Network.
For example, the type of oil used affects how well fats are absorbed. Medium-chain triglycerides, such as palm kernel oil and coconut oil, are digested more easily.
“I try to teach them that to make all these drugs (they’re taking) work the best, that your body’s got to be working its best with nutrition,” Frederick says.
The message needs to be delivered early, when the body is more responsive, adds Lori Nelson, a dietitian at Sacred Heart Medical Center.
“That’s when people still have an appetite, they don’t have to worry about megadosing vitamins and minerals, they eat a healthy diet and they eat fruits and vegetables,” she says.
It’s important to build up protein stores early, Nelson says, because protein needs double for people with HIV.
Food often becomes less attractive to them. Eating can be painful with herpes, thrush and other infections of the mouth, throat and esophagus. The virus can affect the taste and smell receptors.
And patients can become malnourished, even while consuming the same calories they’ve always eaten.
More energy is used to metabolize food. The intestinal tract will not absorb foods as easily, nor is food digested very well. Diarrhea is common.
“I would say that more than 50 percent of patients who have HIV will have gastrointestinal problems,” says Dr. Dan Coulston, a recognized AIDS expert in Spokane.
Stored protein is broken down faster, and lean body mass - muscle, as opposed to fat - is lost.
“One of the symptoms of a person with HIV will be the wasting syndrome, in which they lose tremendous amounts of weight,” says the AIDS Network’s Tomlinson.
Wasting syndrome can develop from the ravages of the disease itself and its effect on the body’s metabolic rate, Coulston says. It also can be caused by infections associated with the virus, or by hormonal dysfunction, which is treated with hormone therapy.
People with AIDS seem to die when their weight reaches a particular point in the wasting process. Dr. Mary Romeyn, in her book, “Nutrition and HIV” (Jossey-Bass, 1995), says this point is at about two-thirds of ideal body weight.
To help meet the need for extra nutrients, liquid nutritional supplements such as Ensure Plus are sometimes recommended.
Coulston sees a place for these “medical foods” with some people. “It’s those patients who have difficulty eating, who have early satiety - they get filled very quickly, and don’t have much of an appetite - where the nutritional supplements can be a benefit,” he says.
“They’re disgusting,” says Fleming, who is glad he’s able to eat real food.
Sacred Heart’s Nelson advocates the use of instant breakfast drinks, which are cheaper than some of the commercial supplements, for added calories and protein. Still, she says, “It’s not a meal replacement, it’s a supplement.”
Medicines taken for HIV and AIDS also can depress the appetite. They can cause diarrhea, constipation and changes in taste.
As a dietitian, Frederick helps people with HIV figure out how medications affect their nutritional needs. Many patients are on “combination therapy,” in which they take a variety of medications before, during or after a meal.
Fleming is fortunate that he uses only six medications, which can be taken at mealtimes. Typically, a person with HIV is on 12 to 25 pills a day, Coulston says.
“What we’ve managed to do is try to modify some of those requirements (of when medications need to be taken), so that patients can have at least some sort of a realistic life and not spend all their time going from one pill to the next,” Coulston says.
Vitamin and mineral supplements, popular with many people these days, are particularly important for those with HIV.
“Research shows they do need more vitamins and minerals than normal,” says Frederick, adding that there are different opinions on how much supplementation is beneficial.
Nelson recommends a multivitamin/mineral supplement that provides 100 percent of the recommended daily allowance. For those who have problems eating, additional vitamin C can help enhance the immune system.
And while food safety is important for everyone, for those with immune diseases, it can be critical.
People with HIV are taught to wash their hands regularly; thoroughly cook meats, fish or poultry; promptly refrigerate foods; throw out old leftovers and use filtered water.
Fleming bleaches his counter tops periodically, and makes sure his cutting board gets properly sterilized.
“Their immune system is already compromised,” Frederick says. “Let’s say you or I got a little food poisoning; we might end up with diarrhea for a day or two. But they’re going to end up in the hospital for a couple of weeks.
“They’re at such risk for secondary or opportunistic infections. If they get a bacteria, it can be deathly.”
The following recipes are from “Positive Cooking, Cooking For People Living With HIV” (Avery Publishing Group, 1997).
Go Ape Shake
This high-carbohydrate drink contains bananas, a fruit high in potassium. It’s good for people with chewing and swallowing difficulties, dry mouth, fatigue, loss of appetite, mouth and throat sores and weight loss.
2 medium-sized ripe bananas, sliced
1-1/2 cups vanilla-flavored low-fat yogurt
1 cup low-fat milk
1 package instant breakfast, any flavor
3 tablespoons honey
Put all the ingredients into a blender and blend until smooth.
Yield: 2 servings.
Nutrition information per serving: 450 calories, 4 grams fat (8 percent fat calories), 88 grams carbohydrate, 16 grams protein.
Prunes, which are high in iron, potassium, fiber and calories, give these muffins a sweet flavor.
3/4 cup white flour
1/2 cup whole-wheat flour
1/2 cup rolled oats
1/3 cup sugar
1/4 cup cornmeal
1/4 cup wheat germ
1-1/2 teaspoons baking powder
1/2 teaspoon baking soda
1 teaspoon ground cinnamon
1/4 teaspoon salt
1 cup chopped prunes
1 cup plain low-fat yogurt
3 tablespoons canola oil
1 egg, lightly beaten
Preheat oven to 400 degrees.
Place the first 10 ingredients (through the salt) in a large bowl and mix thoroughly. Place the remaining ingredients in a separate bowl, and beat well with a wire whisk. Make a well in the center of the dry mixture, and add the wet mixture all at once, stirring until the dry ingredients are just moistened.
Coat muffin cups with nonstick cooking spray, and divide the batter evenly among the cups. Bake for 20 minutes, or until a knife or toothpick inserted into the center comes out clean. Remove the muffins from the pan immediately, and cool on a wire rack.
Yield: 12 muffins.
Nutrition information per serving: 170 calories, 5 grams fat (26 percent fat calories), 29 grams carbohydrate, 5 grams protein.
Dede’s Smashed Sweet Potatoes
This side dish is great for people with chewing and swallowing difficulties, dry mouth, fatigue, loss of appetite, mouth and throat sores, nausea and vomiting, and weight loss.
2 medium-sized sweet potatoes, washed well and cut into pieces
2 medium-sized white potatoes, washed well and cut into pieces
1/2 cup low-fat cottage cheese
1/2 cup evaporated skim milk
1/4 cup nonfat dry milk powder
1/2 teaspoon salt
1 teaspoon black pepper
Place the potatoes in a large saucepan over high heat, and cover with water. Boil for 15 minutes or until tender. Drain.
Place the potatoes and the remaining ingredients in a large bowl, and beat with an electric mixer until smooth. You can also mash the potatoes by hand, using either a potato masher or a large spoon. Serve immediately.
Yield: 4 servings.
Nutrition information per serving: 180 calories, 1 gram fat (5 percent fat calories), 34 grams carbohydrate, 10 grams protein.
This entree is designed for people who have alterations in taste, constipation, fatigue and weight loss.
1 pound extra-lean ground beef
2 cans (15 ounces each) creamed corn
3/4 cup cornmeal
1 (15-ounce) can tomato sauce
1 teaspoon dry taco seasoning
1 (4-ounce) can sliced olives
Preheat the oven to 400 degrees.
Place the beef in a large nonstick frying pan, and cook until no longer pink, about 8 to 10 minutes. Drain off any fat. Add the remaining ingredients and mix thoroughly.
Coat a 9- by 13-inch baking dish with nonstick cooking spray. Pour the meat mixture into the dish, and bake for 30 minutes or until thoroughly heated. Serve immediately.
Yield: 4 servings.
Nutrition information per serving: 485 calories, 16 grams fat (30 percent fat calories), 64 grams carbohydrate, 28 grams protein.
, DataTimes ILLUSTRATION: 3 Photos (2 Color)
MEMO: This sidebar appeared with the story: MORE INFO Here are some sources for more information about nutrition and HIV: Annie Frederick, registered dietitian with National Medical Care in Spokane (921-6560); printed information and nutrition counseling. The Spokane Regional Health District’s HIV/AIDS hotline, 324-1543 or (800) 456-3236. Spokane AIDS Network (455-8993); information packets, and videotapes that can be loaned to clients. S.T.E.P. (Seattle Treatment Education Project), at (800) 869-STEP. National HIV/AIDS Information Clearing House, (800) 458-5231. The American Dietetic Association has a booklet called “Living Well with HIV: A Guide to Healthy Eating.” Call (800) 877-1600, ext. 5000.
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