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Outsmarting HIV With Healthy Eating

January/February 2012

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Outsmarting HIV With Healthy Eating

Living with a chronic illness like HIV can present certain nutritional challenges. Without effective HIV medication treatment, replicating virus can tax the body, destroying lean body mass and impairing immune function and quality of life.1,2

While this destruction of lean tissue can be controlled with effective HIV antiretroviral combination therapy, other challenges like fat accumulation and increases in lipids (cholesterol and triglycerides) and/or insulin resistance may arise in some patients after treatment initiation.3 Although limited research has been done on the effects of nutritional approaches on pre- and post-HAART (highly active antiretroviral therapy) metabolic issues, general suggestions can be extracted from studies regarding other conditions like diabetes, cardiovascular disease, and obesity. These suggestions are aimed at helping the body deal with the effects of HIV or its medications on metabolism, body shape, and quality of life as we live longer with HIV.


The Components of Whole Food

Foods are made up of many different components -- some are "micro" or smaller quantity nutrients, like vitamins, and some are "macro" or larger quantity nutrients. The three macro groups that compose the majority of our diets are carbohydrates, proteins, and fats. These three units are the basic materials that fuel our activities and metabolism and maintain body composition. Selecting the best sources and amounts of these three macronutrients may help to minimize metabolic disorders (such as high cholesterol and blood sugar) and prevent loss of lean body mass and accumulation of body fat.4-6


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The Best Carbohydrates

Carbohydrates provide our body's main source of quick energy. After carbohydrates are digested and after some processing by the liver, they are released into the bloodstream as a sugar called glucose to be delivered to the cells.

Throughout the majority of the last million years of our evolution, the human diet consisted of animal carcasses, some seeds, nuts, and fibrous vegetable and fruit carbohydrate sources that are generally nutrient-rich with lots of water, but are not calorie-dense like processed foods of today. The majority of these carbohydrate sources are vegetables, leaves, roots, and fruits (all rich in fiber). Because vegetable fiber tends to slow down digestion, a majority of the carbohydrates in these foods are absorbed relatively slowly, inducing less blood sugar (glucose) and insulin spikes than processed sweets that contain no fiber. Some people call these "slow carbs."

It was only after the advent of agriculture that human beings were introduced to higher intakes of grains as carbohydrate sources. Higher intakes of grains deliver lots of calories. Additionally, some grains deliver their sugar energy relatively quickly, especially if the grain is milled (which removes the fiber that slows down sugar absorption), as are the grains in breads and pasta. Unless you are very active and exercise enough to metabolize nutrients more rapidly, this quick glucose release into the bloodstream can create a dysfunctional hormonal environment that can ultimately promote obesity, cardiovascular disease, and diabetes. This hormonal shift also has a profound effect on lean body mass and fat metabolism, and possibly immune function.7-9 The key hormone involved in this problem is called insulin, produced by an organ called the pancreas.


Insulin and Insulin Resistance

The hormone insulin is produced by the pancreas to control blood sugar and store it in muscles for later use as glycogen. Insulin's main job in the body is to promote the delivery of sugar energy as glucose to cells. When a small amount of glucose is delivered into the bloodstream, a small amount of insulin is produced by the pancreas to accompany it. When there is a large amount of glucose, the pancreas works to produce a large amount of insulin to facilitate its delivery so that cells can take in as much glucose as possible. Extra glucose that cannot be taken in by the cells circulates in the bloodstream and can be toxic to brain cells, so under normal circumstances, most of it is soon converted into triglycerides (fat) in the liver to be stored for later use. But we have to be careful with high blood levels of triglycerides, since they are what feed fat cells.

The correct amount of carbohydrate sources will provide enough sugar to give a healthy amount of glucose to the cells, but not too much at once. Thus, levels of glucose and insulin in the bloodstream are not unusually elevated for any long period of time. The pancreas works, but it is not overworked trying to keep up with an unusual demand for insulin.10 However, in the U.S., much of the diet consists not only of large amounts of high-calorie carbohydrate sources, but also of carbohydrates from sweets and sodas, which are very concentrated sources of sugar. The net effect that intake of these calorie-dense carbohydrate foods creates is a bloodstream that is occasionally flooded with large amounts of glucose, a pancreas that is overworked, and large amounts of insulin and triglycerides circulating in the bloodstream. Note that excess insulin causes increased production of cholesterol.

Over time, these occasional glucose, triglyceride, and insulin floods can cause a decrease in the sensitivity of the cells' response to insulin, which reduces the cells' ability to take in glucose. Insensitivity to insulin is called insulin resistance, and it is a serious consideration in HIV because we are now seeing it as one of the core components of lipodystrophy and metabolic problems.11 Some HIV medications can worsen insulin resistance, so we need to be aware of nutritional considerations that can help. Ways to decrease insulin resistance are to exercise, choose more metabolic-friendly HIV medications, and follow a proper diet. For instance, a prominent study from Tufts School of Medicine found that HIV-positive people consuming an overall high-quality diet, rich in fiber and adequate in energy and protein, were less likely to develop fat deposition.12 This is why it is best to select the majority of your carbohydrate intake from fiber-rich, slow-releasing carbohydrate sources that do not contain an excessive amount of calories. And these good carbs should be accompanied by good sources of protein and fats.


Combining Carbohydrates With Protein, Fiber and Fat

Protein, fiber, or fat will slow the absorption into the blood of glucose from carbohydrates, which helps to reduce the rise in blood sugar and insulin spikes. So, mixing carbohydrates with protein, fiber, and good fats is one way to reduce their problematic effect on blood sugar and insulin. Ensure that every meal and snack you consume has a mix of these three macronutrients. But what are the best fats, protein, and high-fiber carbohydrates sources out there?


Fats and Oils

There are a number of different kinds of fats. There is motor oil, there is butter, and there are essential fatty acids. The most important oil to keep a Honda running right is not the kind with essential fatty acids (EFAs), but if you want to help your body stay healthy and your immune system operating at its best, you had better consider getting these EFAs on a daily basis. They are called "essential" because your body cannot manufacture them, and must obtain them from an outside source, like food or supplements. These oils are necessary for every critical function in your metabolism, including building lean body mass and fighting infections.

The main point is that since we need EFAs and other fats for health, we should be getting them in our diets from fresh, high-quality sources. A proper diet reduces the amount of starchy carbohydrates while maintaining a certain amount of healthy fats so that there is a different macronutrient balance than the old high-carbohydrate, high-protein, low-fat diets contained. This means striving to get fatty acids from several sources, the least of which are the saturated fats in butter or animal fat. Understand that saturated fats are not the demons we have been led to believe. When we realize that we evolved getting a certain amount of saturated fat from foods in the wild, it is only logical that they would have a place in a healthy diet. One recent study showed that dietary saturated fat and mono-unsaturated fat were associated with healthy testosterone production in humans, while EFAs had no effect. So it appears that we need a little saturated fat for optimal hormonal health. However, most people get far too much saturated fat, which promotes insulin resistance and metabolic problems, and not enough EFAs, which are needed for healthy cells and immune function.13

The other important kind of fat that we should consciously include in our daily diet is mono-unsaturated fat, which we get from foods like olive oil. Recent data have shown that mono-unsaturated fats decrease the risk of certain cancers, and have an anti-inflammatory effect.14 AIDS is an inflammatory disease, so mono-unsaturated fat intake logically has a place of importance in managing AIDS, too.

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This article was provided by Positively Aware. It is a part of the publication Positively Aware. Visit Positively Aware's website to find out more about the publication.
 
See Also
An Introduction to Dietary Supplements for People Living With HIV/AIDS
Ask a Question About Diet or Nutrition at TheBody.com's "Ask the Experts" Forums
More on Diet, Nutrition and HIV/AIDS
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Reader Comments:

Comment by: kim (florida) Wed., Aug. 7, 2013 at 3:42 am EDT
The best diet for your health is a vegan diet. Read the China Study by T. Colin Campbell. A vegan diet will not only optimize your health but also the health of the planet and countless animals that share the planet with us.
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Comment by: Anthony B. (Salt Lake City, UT) Thu., Oct. 18, 2012 at 7:50 pm EDT
Hello Mr. Vergel,

Thank you for this great article. I wondered in the "Healthy Eating Shopping List" under the Dairy section, can you suggest another kind of milk other than low fat? I usually drink whole milk, and I don't usually like the taste of the lower kind - 2% etc. Can I substitute this with perhaps soy milk? or another kind of milk?

Thanks again for the great article.

Anthony.
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Comment by: Jeanne B. (Milwaukee, WI) Thu., Mar. 8, 2012 at 5:11 pm EST
Excellent article
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Comment by: mary (dar es salaam) Mon., Mar. 5, 2012 at 10:40 pm EST
thanks for ur news im the one who have HIV from 1999 i use HIV drug from2007
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Comment by: Peter (San Francisco) Fri., Mar. 2, 2012 at 12:40 am EST
Great tips - this pretty much represents my own diet, right down to the almond butter sandwich at night! I did want to note that if one is taking a fiber supplement, precautions regarding timing of the supplement must be observed. Basically one should not take a fiber supplement within a few hours (before or after) of taking medications, because it can interfere with absorption. The labels on most fiber supplements have information regarding timing.
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Comment by: Ellen Levine (New York) Fri., Feb. 24, 2012 at 12:14 pm EST
Nelson - I am an RD working in HIV nutrition for many years. I find this article just right on. I like your well rounded and well researched approach, and your emphasis on using real foods in the diet, as well as lean meats and eggs, which many people are afraid to eat these days. I also love your emphasis on the vegetables, fruits. You are knowledgeable, and I plan to use this piece as a basis for some of the talks I give. Thanks.
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Comment by: amy (Illinois) Thu., Feb. 23, 2012 at 4:09 pm EST
Meat and Dairy are not necessary. Many successful athletes from ultramarathon runners to body builders are vegans. I believe people like myself who are living with HIV will feel and stay healthier on a proper vegan or at least a vegetarian diet.
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Comment by: kim (Florida) Thu., Feb. 23, 2012 at 2:19 pm EST
Dairy and meat are NOT healthy for people, the animals that suffer horrendously or the planet. The number one cause of global warming is animal agriculture. Vegetarians and Vegans are much healthier if they follow a balanced diet of whole grains, unprocessed foods and dark, leafy, green vegetables. Research shows that vegetarians have less cancer and heart disease. Vegans only need to supplement vitamin B12. I have been living with hiv since 1988 and on antivirals since 1998. I have always followed a vegetarian or vegan diet with no loss in lean body mass, lipodystrophy or other physical issues. Please try to consider other sentient beings on this planet. The medication we rely on each day to survive has destroyed billions of precious lives already. Isn't it time to save a few lives in return. And, just think how you and the planet will be healthier for having merely changed your diet.

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