Can People With HIV Eat Sushi? Your HIV and Diet Questions Answered

Joanna Eveland, M.D.
Joanna Eveland, M.D.

Eating the right kinds of food and maintaining a balanced diet are key to maintaining overall health. For people with HIV, the association between nutrition and health is even more pronounced. Most of my patients have their HIV well controlled but have high blood pressure, high cholesterol or are at risk of developing diabetes -- all conditions connected to nutrition. I tell my patients that planning and eating nutritious meals is just as important as remembering to take your HIV medicines every day.

Food is medicine, and eating the right kinds of foods can result in more energy, less stomach upset, stronger bones, a more robust immune system and a healthier heart. I'm always happy when -- instead of prescribing more pills -- we can fix a patient's health problem with a change in diet.

In the early days of the AIDS epidemic, HIV providers used to worry about wasting and weight loss due to HIV. With the development of better HIV medicines, people are living longer and there's less worry that they'll develop opportunistic infections. Instead, the top health concerns for people with HIV are the same nutrition and diet-associated health problems faced by other Americans, like becoming overweight or obese. I often worry more about the impact of fast food and soda on my patients than I do about them getting sick from something related to HIV. My patients worry about the long-term effects of HIV and HIV medicines on their liver, kidney, or bones, but a poor diet can actually be the more pressing concern.

As much as we all want to eat healthily, it can be difficult. For most of us, food can be a source of comfort and a way to cope with emotional stress. When things get busy or tough, we often turn to the sugary, salty, high-fat foods that make us feel full and satisfied fast. For many of us, it's hard to find time to shop for food and cook at home. For those on a fixed income, buying healthy food often competes with other priorities. And it also feels like nutrition guidelines are always changing. How do we even keep up?

To address these concerns, I asked registered dietitian Kristi Friesen from Project Open Hand to attend a San Francisco AIDS Foundation Positive Force event to answer questions that people with HIV have about diet and nutrition. Here's what we learned.

Do people with HIV need to eat more protein?

Kristi Friesen: The short answer is no. Overall, in our population we're seeing more and more damage being done from people eating a high protein diet. It's hard for the kidneys to process too much protein. It's important to have some protein at every meal -- but there's no need to buy protein powders or have more than a quarter of your plate be a high-protein food.

I've heard that people with HIV shouldn't eat sushi. Is that true?

Kristi Friesen: It's true that people with compromised immune systems need to be more careful about food poisoning, since you may be more likely to get sick from eating uncooked or improperly cooked food. With raw fish, there's a risk that, because the food hasn't been heated, there's bacterial contamination. I'd advise that if you want to eat sushi, be careful about where you're eating it. Go to restaurants that you can trust store their food properly. Be wary about sushi boat places if you see the plates of sushi circulating for a long time.

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