What's for Breakfast (and Lunch and Dinner)?

HIV and What You Eat, Drink and Take

What's for Breakfast (and Lunch and Dinner)?   What's for Breakfast (and Lunch and Dinner)?   What's for Breakfast (and Lunch and Dinner)?

All your life you've heard it -- "Eat your vegetables or there will be no dessert!"

"Most Americans don't eat enough fruits and vegetables."

"Want to lose weight? Cut out the carbs!"

I don't know about you, but I'd love it if there were some reason not to eat vegetables (say, like, the E. coli thing with spinach?), whole grains (mealy bugs in the bran?), and please, please someone stop the insanity of mothers trying to convince their kids that raisins or apples are "just as good" as candy!

The fact is that most can agree that in order to maintain optimum health, whether you're HIV-positive or not, it's best to exercise our option to fulfill the human dietary destiny of being omnivores, or able to eat everything. Of course, there are those among us for whom a vegetarian, raw, or macrobiotic diet would work perfectly, just as there are those who are meant to be meat-eaters. Whatever is right for you, there are some basics that anyone living with HIV should factor into their food choices.


If there is any good news about being HIV-positive, one bit may be that you now have a legitimate need to take in more calories, especially during times of fighting opportunistic infections. The Tufts School of Medicine recommends that HIV-positive people need 17-20 calories per pound of body weight; if you're fighting an opportunistic infection, 20 calories per pound for sure; if you're losing weight, 25 calories per pound.

While it's true that, from a strictly caloric standpoint, your body can't tell the difference between the calories in a piece of candy and the ones in a bowl of fresh fruit salad, remember that the ones from the fruit come with other things that will help keep you healthier than the sugar in the candy.

More Protein, Better Fat

In general, HIV-positive people need higher amounts of protein in order to maintain good muscle mass and provide building blocks for the immune system. Of course, meats, fish, poultry, and eggs are high in protein, but vegetarians can also find it in nuts and seeds, tofu, legumes (beans and peas, often dried), dairy products, and soy milk. A good rule of thumb is to eat one gram of protein for every two pounds of body weight -- so if you weigh 160, 80 grams (around 3 ounces) of protein per day would be appropriate.

Fats and oils provide the most concentrated sources of energy in the food spectrum, but there are some that carry some risk, in terms of cardiac complications. The most evil kind of fat is trans fat. No, this is not fat that is going through the sex-change process. One way to look at it is that these substances tend to be man-made or modified (partially hydrogenated vegetable oil, for instance), rather than fats found in nature. The fat in that chicken skin everyone tells you to peel off is a saturated fat -- saturated fats should be limited to small amounts. Monounsaturated fats contain essential fatty acids that we all need and are the healthiest kind of fat. Olive, canola, flaxseed oils, avocados, and nuts contain these fats.

Color and Diversity

Just as in humanity, there is an array of different colors and types of vegetables and fruits. These gifts of nature are full of vitamins, minerals, and fiber, all important for maintaining your health. They also have antioxidant and anti-inflammatory properties. General dietary guidelines say you should have 5-6 servings of fruits and vegetables every day. To get the full range of nutrients they provide, eat a variety of colors. Be aware, however, especially if diabetes is an issue, that these gems can contain fructose, a kind of sugar, as in pineapple and beets, and carbohydrates from starch, as in potatoes and corn. For the most part, though, the benefits of the nutrients and fiber far outweigh any risk of sugar or carb overload, so don't use that as an excuse not to eat them!

Complexity Over Simplicity

The thing about carbohydrates is that we literally can't live without them. They provide the calories and energy necessary for everything from the beating of our hearts to carrying the laundry up the stairs to hugging our loved ones. Just as with fats, there are some that are healthier than others and of course, the worst ones taste the best!

Simple carbs are those found in sugary drinks, baked goods, candy, ice cream -- all that stuff you want to eat, but know you shouldn't. Not that complex carbs are always less than joyful. Nothing beats a creamy bowl of oatmeal on a winter morning or really good toasted multigrain bread with your eggs. Pasta and brown rice are also good with the right accompaniments. So think about it in terms of conversation -- wouldn't you rather have a stimulating conversation with an average, intelligent, complex person than a gorgeous, dumb, simple one? Okay, sigh, well, maybe that analogy doesn't work for everyone, but you get the point!


Water is something else we can't live without. A person deprived of water will die faster than one deprived of food. Several of the antiretroviral medications (such as Viread, Crixivan, and Reyataz) require increased water intake in order to prevent kidney complications. And, sorry, but Diet Coke doesn't count! Anything you drink that contains caffeine (coffee, most tea, soda) is not going to hydrate your body like water. Fruit juices and milk are liquids that contain good nutrients, but they also contain fructose and lactose, types of sugar. Bottom line is that nothing can really replace water. Don't like it? Put a slice of lemon or lime in it to give it some flavor and it will also help you with your alkaline balance.

The Add-Ons

With all the information that's available from sources like your mother to your doctor to the Internet, you may find yourself becoming obsessed with always eating, drinking, or taking the "right thing."

Vitamins and mineral supplements, enzymes, and, my personal favorite, herbs can all be important parts of your plan for stayin' alive -- it has been reported that up to 73% of people with HIV have used some form of such alternative or complementary therapies. However, it is absolutely essential to discuss any planned additions with your doctor or nutritionist. Don't just read something in a magazine or online and start taking it without telling your doc -- you could do more harm than good!

When you consider taking a botanical medicine, you will probably hear a lot about how they can interfere with your pharmaceutical meds. Most of the time, this is more about the infamous P450 metabolic pathway than it is about the chemical constituents clashing.

The majority of pharmaceuticals, herbs, and recreational drugs are metabolized, or processed, through the liver on this particular pathway. When these substances are taken together, the metabolic "traffic jam" that ensues can result in lowering or raising the blood levels of the medicines, thereby reducing their efficacy or increasing their side effects or toxicities.

Though there has been a double-blind study done (see sidebar) with ginkgo, ginseng, and some common pharmaceuticals that indicates that those herbs, while traveling the P450 highway at the same time as the pharmaceuticals, had no negative effect on the blood levels or efficacy of the drugs, even I, as an herbalist, endorse the "better safe than sorry" approach. There is plenty of literature available, including our annual HIV Drug Guide, which will warn you about what herbs not to take with which ARV meds.

Sadly, many Western medical providers don't know much about the potential therapeutic or contraindicative properties of herbs and other botanical medicines. Therefore, it's up to you to do your homework! Before you talk to your care provider, do some research on the Internet or in your public library. If possible, consult a certified herbalist. In any case, go into the discussion with as much information as you can gather about the botanicals you're considering. While some physicians may be firmly against your choice to try alternative or complementary therapies, many will welcome the opportunity to learn about some of the things their patients are interested in adding to their health care regimen.

More Science

It's generally recommended that HIV-positive people take a multi-vitamin.

Much more scientific knowledge is available for vitamins, minerals, enzymes, and other supplements. It's generally recommended that HIV-positive people take a multi-vitamin, especially if you know that you're not getting all the nutrients you need in the food you eat. Vitamin C is also frequently recommended for its excellent antioxidant properties.

TheBody.com has an excellent chart that lists the major vitamins, dosages, functions, possible toxic effects, and food sources. See "Resources" below for the link.

Other supplements, including amino acids (like N-acetyl cysteine [NAC] and L-glutamine), organisms (like acidophilus), and substances the body makes (such as CoQ10 and alpha lipoic acid) can have positive effects on such things as neuropathy, diarrhea, digestive problems, and heart health. TheBody.com also has a list of these supplements at the same link.

Resist OCD

With all the information that's available from sources like your mother to your doctor to the Internet, you may find yourself becoming obsessed with always eating, drinking, or taking the "right thing." There are a lot of things that HIV takes out of your control, so being able to "be in charge" through your food and supplement choices can be reassuring and empowering.

But food is also one of the ways we humans have to show our love, to celebrate, to ritualize, to comfort and reward ourselves, and simply to experience joy. Recognize that allowing yourself to do all those things occasionally, even with food that's "naughty," or not of the highest nutritional value, can be therapeutic too.

As the saying goes, moderation in all things.


The National Institutes of Health (NIH) are currently enrolling a study of healthy, HIV-negative individuals to assess whether there is an interaction between the protease inhibitor Kaletra (lopinavir/ritonavir) and the herbs echinacea, ginkgo, and ginseng. To find out more, visit www.clinicaltrials.gov and use the study identification number, NCT00103012, to search for it.

An HIV-specific chart listing vitamins and supplements is available at:


For listings of professional herbalists, visit:


Ginkgo and Ginseng

In 2007, Dr. Gregory Reed, of the University of Kansas Medical Center, conducted a study that found that the recommended daily doses of ginseng and ginkgo biloba supplements, or the combination of both supplements, are unlikely to alter the pharmacokinetics -- the mechanisms by which drugs are metabolized, distributed, absorbed, and eliminated by the body -- of the majority of prescription or over-the counter drugs.

The research team recruited 72 healthy non-smoking adults (31 men and 41 women, ages 20 to 59) who were not taking any prescription drugs or dietary supplements. The participants were given a "cocktail" of five drugs, which, taken together, provide measurements of the pathways that determine the pharmacokinetics of over 90% of prescription drugs. The scientists measured the presence of these drugs or their metabolites in each subject's blood and urine in order to establish a baseline for how each individual metabolized and absorbed the different prescription drugs in the absence of herbal supplements.

The 72 individuals were then assigned to one of four groups. For four weeks, the first group received a ginseng supplement and a placebo for ginkgo; the second received ginkgo and a placebo for ginseng; the third received both ginseng and ginkgo supplements; and the fourth received placebos for both supplements. The prescription drug cocktail was again administered and blood and urine samples were taken in order to determine the metabolism and absorption of these drugs in the presence of either or both of the herbal supplements.

The study found no significant differences between those who received one, both, or none of the ginseng and ginkgo biloba supplements in how their bodies metabolized or absorbed any of the five prescription drugs. These results suggest that neither ginseng nor ginkgo at recommended doses will affect the pharmacokinetics of the majority of prescription or over-the counter drugs, though it should be noted that the pharmaceuticals that were taken in the study were not antiretrovirals (ARVs) and no such study has been done on ARVs specifically.

This study was supported by the National Center for Complementary and Alternative Medicine of the National Institutes of Health.

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