Research on drug therapies is traditionally given a higher priority than research into nutrition due to profit potentials. Put simply, protease inhibitors generate significantly more profits than bananas. Since there are so many variations among individuals living with HIV, studies looking at micronutrients have produced inconsistent results. Unlike studies examining the role of vitamins and minerals in HIV, little research is available on specific diets appropriate for this population.

Fad diets and quackery develop from research uncertainties and the vulnerability of individuals searching for simple solutions to health concerns (with weight loss often being the desired outcome). The United States Department of Agriculture's preliminary research on popular weight loss diets finds that most of them do result in weight loss. The micro- and macronutrient composition is not as crucial as the caloric composition of diets. Typically, the diets provide 1,400 to 1,500 calories per day. But many diets are short-lived and don't teach people how to change their eating habits or prepare them to eat well-balanced meals. Once the interest in adhering to the diet wanes, former food habits are resumed and the weight is regained. This is called the "yo-yo effect," on the principle that what goes up must go down (visa versa in this case).

With concern about immunity and the potential of certain foods to provide energy and strength, diets advertising these sought-after results have gained popularity in mainstream media. Individuals can be bombarded with alarming advice. Here are two extreme examples:

In 1995, Michael Kent Bilbrey was arrested in Chandler, Arizona for selling a quack potion as a cure of AIDS. He was charged with theft and ordered to pay a restitution of $39,300 after his "potion" was found to have no scientific justification since it consisted of nothing more than cranberry juice, saline solution and household bleach.

In 1993, Herbert Saunders, a farmer in Minnesota, convinced numerous customers to buy a cow for $2,500 and pay up to $35 a bottle for its milk, claiming it as a cure for AIDS and other diseases. He reportedly injected a patient's blood sample into the cow's udder to theoretically produce antibodies for the disease. Saunders has not been arrested and still defends his actions.

A nutritionally balanced high-protein, low-fat diet that includes a variety of foods is often promoted for maintaining optimal nutrition status. The goal of the general diet recommendation is to ensure adequate intake of all nutrients, to maintain weight and muscle mass and reduce the risk of malnutrition.

High-Protein, Low-Carbohydrate Diet

HIV-positive individuals are encouraged to generally eat as much protein and as many different kinds of food as they can without regard for exact diet composition. As a result, some people choose to follow a high-protein, low-carbohydrate diet often promoted. Many people experience sudden weight loss on these low-calorie diets due to water loss, with the false impression that fat loss has occurred. In addition to sudden weight loss not being ideal since it leads to dehydration and the loss of muscle protein, this type of diet provides inadequate amounts of vitamins A, B and E, certain minerals, and dietary fiber. This diet may also have other negative results including a higher saturated fat intake (from animal protein sources), a higher demand on the liver and kidneys in breaking down protein to its digestive form (amino acids), the formation of kidney stones, and an increased risk for osteoporosis (a disease where your bones become very brittle and fracture easily).

Vegetarian Diets

Plant-based, vegetarian diets are rich in whole grains, fruits, vegetables, legumes, nuts and seeds, and are low in saturated fat and cholesterol. People on vegetarian diets generally have reduced incidences of cardiovascular disease, cancer, diabetes, hypertension, and gastrointestinal abnormalities. Protective components of the foods vegetarians consume include fiber, phytochemicals, vitamins and minerals. Although considered healthier than a typical Western diet and therapeutic for people with various chronic diseases, this diet may pose a challenge for people living with HIV who have increased nutritional needs. A vegetarian diet can be too low in calories and protein essential for maintaining weight and lean muscle mass long-term. Therefore, an HIV-positive individual may need additional protein, calorie and vitamin B12 supplementation (since vitamin B12 is found primarily in animal foods).

Macrobiotic Diets

Macrobiotics, from the Greek ("macro" meaning "large" or "long", and "bios" meaning "life"), is a way of eating and living that incorporates only whole foods and foods processed by traditional methods. Today, our interpretation of macrobiotic lifestyle is based on the teachings of the modern father of macrobiotics George Ohsawa and his student Michio Kushi. Based on the belief that we're continually influenced by environmental factors including food, climate, geographic location, activity and physiology, this approach views illness as the body's effort to return to harmony with the natural environment. Consuming a wholesome diet is the direct path to reestablishing this balance.

People are encouraged to foster a further connection to the environment by eating regionally grown foods appropriate for the climate. For example, most residents of the United States live where whole grains, beans, seeds, vegetables and some fruits are grown naturally. In this area, dairy products, red meat and poultry are generally not recommended. As foods are to be eaten as close to their natural form as possible, highly processed foods with additives are to be avoided. Further, traditional preparation and cooking methods, such as steaming or lightly sautéing, which preserve nutrients and enhance flavor, are suggested.

Macrobiotics is guided by the principles of yin and yang -- the interrelationship between opposites. Foods are either yin, creating expansion, or yang, causing contraction. Further, foods are categorized into two groups: acid-forming or alkaline-forming. The bulk of energy, 50-60%, comes from whole grains (complex carbohydrates), followed by 20-30% from vegetables, 5-10% from soups, and 5-10% from beans and sea vegetables. A small percentage of the diet consists of condiments, beverages, fish, desserts and supplementary foods. This breaks down to 12% protein, 15% fat, 73% complex carbohydrate, and 0% refined sugar. Although this diet is primarily vegetarian, small amounts of white meat fish and some shellfish can be included. The macrobiotic diet favors sources of protein low in saturated fat and cholesterol such as traditionally processed tofu, tempeh and seitan (wheat gluten).

According to Kushi, the gradual breakdown of natural immunity occurring through poor diet and other health habits is responsible for increased susceptibility to harmful viruses and bacteria. The modern diet, consisting of mostly acid-forming and yin foods, leads to imbalance and weakening of health and immunity.

Immune support through adherence to the macrobiotic lifestyle has been promoted as a treatment for HIV by some holistic healers, but little research has been conducted by the Western medical community to evaluate its efficacy. In the mid-1980's, a small group of nine men in New York City with AIDS following a macrobiotic regimen within one to twelve months of diagnosis were monitored for several years by E.M. Levy and colleagues from the Boston University School of Medicine. Through blood samples, clinical observations and participant questionnaires, the researchers found an increase in CD4 numbers. Additionally, participants reported less fatigue, a sense of well-being and a better quality of life. The researchers noted that this psychological component of the intervention might influence disease progression.

Yeast-Free Diets

The reduction of the yeast, candida albicans, is the primary focus of this diet and has been promoted to people with HIV suffering from thrush (candidiasis). To reduce the growth of yeast infections, the diet calls for the avoidance of yeast, sugar, fruits, grains, nuts, milk, wheat, caffeine, nicotine and alcohol. No controlled clinical trials have been conducted to substantiate the diet's validity for treating candidiasis, yet some individuals claim that it has been beneficial.

Asking Questions About Research

To assist in making informed decisions when interpreting diet information, here are a few questions to ask yourself:

  • Does it sound too good to be true or make claims of being superior to conventional diets?

  • Does it promise a "quick-fix" or require that certain foods be avoided or eaten at specific times of the day?

  • Has the diet been in existence for a substantial amount of time?

  • Have any harmful side effects or dangers been reported in individuals following the diet?

  • What type of study was used to justify claims? Was it a controlled study? Was the study conducted in humans or animals?

  • How large was the study population and how long did it last?

  • Was the study ever repeated to confirm the findings?

  • Were the results published in a peer-reviewed journal, and did they provide details about the study design and disclose limitations of the study?

Making the Right Choices

The beginning of any meaningful diet change is self-assessment. Working with a registered dietitian, you can assess your current diet by completing a food record or food frequency questionnaire. These are useful tools to examine the adequacy of eating patterns and for identifying specific areas needing improvement. The goal of health promotion through improved dietary habits, rather than adherence to a strict eating plan, will lead to overall improvements in health.

Anya Romanowski, M.S., R.D., C.D.N. is the Director of Nutrition Services at God's Love We Deliver. She also offers her services to other New York City non-profit organizations as a nutrition consultant.

Lisa Zullig, M.S., R.D. is an HIV Nutrition Specialist at God's Love We Deliver and at Michael Callen-Audre Lorde Community Health Center.