Nutrition & HIV: Sizing Up Serving Sizes

Does Size Matter?

Yes. The terms "small," "medium," and "large" mean different things to different people, and there are no standard definitions.

Not so long ago, a small drink meant six ounces, medium was eight ounces, large was twelve ounces and extra large was sixteen ounces. Now, in too many settings, small, medium, large, and extra large can mean more than twice these amounts.

Does this mean that these new sizes are the right amounts to consume? No. It just means that is the amount being sold.

A "glass" or "cup" can mean four ounces, twelve ounces, or even as much as forty-four ounces. A bowl of cereal can be as little as a half-cup dessert bowl or as much as a small mixing bowl.

You want to make sure your food and drink intake provides adequate calories, protein, vitamins and minerals, fiber, fluid, and other important substances. Meeting your nutritional needs is necessary to maintain weight and lean body mass, and to avoid nutrient deficiencies.

What you eat and the amount you eat matters, especially when you have trouble maintaining weight or you need to gain or lose weight. If you are running high blood sugar levels or if you are running abnormal blood lipids, that also makes a big difference.

Read the Label

Look for the label titled "Nutrition Facts" to give you the basic nutrient analysis of the food or drink you are consuming.

Among other things, the Nutrition Facts label indicates the total fat, saturated fat, cholesterol, sodium, total carbohydrates, and fiber per portion of that food or drink, the recommended daily goals for each of those substances, and the percentage of the daily goals met by the particular food. Pay attention to the numbers on the label and how much you are actually consuming.

First, look at the label to see how many serving sizes are in the container. Sometimes the label indicates that there are actually two or more servings in what you thought would be a single serving.

Second, measure how much you are consuming. You probably will need to get a measuring cup and measuring spoons to accurately judge the amount you are eating or drinking. After you practice measuring your food and drink for a while, you will become good at knowing portion sizes. Eventually you will train yourself to better eyeball volume amounts and your hand will become more sensitive to weights.

Become more familiar with the label, the quantity you are consuming, and how foods compare with each other.

The following chart shows the daily values listed on the label, which serve as the basic guide for most Americans. Remember: no one diet prescription applies to all people. Based upon height, weight, activity, gender and illness factors, people have different caloric needs.

 2,000 cal.2,500 cal.
Total Fat< 65 g80 g
Saturated Fat< 20 g25 g
Cholesterol< 300 mg300 mg
Sodium< 2,400 mg2,400 mg
Total Carbohydrates< 300 g375 g
Dietary Fiber 30 g

People with HIV often have a variety of special nutritional concerns and complications. Nutrition assessments should be performed to better estimate caloric and nutrient requirements, and to determine if intake meets those needs.

How Many Calories are In a Gram?

Calories come from carbohydrate, fat and protein, and also are listed on the nutrition label.

Misleading Messages

The public receives messages to purchase and consume more than what is needed or even healthy. In today's marketplace, many examples of such promotions can be found.

One example currently seen around L.A. is a billboard depicting a little girl about four years old. In the picture, the girl is holding a glass of milk that could easily be twelve or even sixteen ounces: far, far, more than what a little one is developmentally ready to be holding or drinking at one time.

Three servings of milk products a day are recommended for children. A reasonable serving size of milk for a four-year-old is about four to six ounces in a smaller, more manageable glass served at each meal and a couple of snacks each day.

This billboard sends a misleading message about portion sizes to children and their parents and providers. Like most other products, milk should be provided in smaller serving sizes given at meals or at a snack.

Danger of Overconsumption

Is consuming great quantities at one time wrong?

Occasional splurges happen, but they should be the rare exception, not the rule. No one benefits from consuming such huge quantities. Carbonated and juice drinks that are served in large-sized containers are examples of profitable marketing and not healthful food options. If you are so thirsty that you need to drink a lot, drink water.

Are exaggerated marketing promotions harmful? As a professional dietitian and health advocate, I say yes. Weight gain and obesity in the U.S. has increased dramatically in both children and adults. Obesity is associated with the promotion of insulin resistance and diabetes, hypertension, cardiovascular diseases, cancer and other chronic and life-threatening conditions. Now these nutritional concerns are increasingly facing many people with HIV.

Maintaining control over ingredients and portion sizes is easier when food is prepared and eaten at home. Children and adults are increasingly eating alone and eating outside the home. Such indiscriminate eating can add up to excessive calorie and fat intake. Take steps to establish meal times for your family, whatever your family structure.

Nutrition studies have shown that overweight people tend to under-report what they are eating and underweight folks tend to over-report. Even though individuals' self-reporting on dietary intakes may not be one hundred percent accurate, just writing down everything you eat and drink over one day is an important step in increasing your awareness to help you make changes. Being aware of what you are eating is a necessary step to improving dietary intake and behaviors.

Individuals can envision the amounts they serve themselves, and they become familiar with how to quantify them. How much meat, bread, mayonnaise, and lettuce is on that sandwich?

By using plastic models of foods and samples of various sized cans, drinking glasses, and containers, individuals get a clear idea of what standard serving sizes look like and ultimately a reality check as to what they think they are eating.

The unavailabilty of small portions is a public health disservice. Getting a larger amount of drink or food for just a few pennies more may seem like a real deal and good value for your money. The opposite is more often the truth. These greater amounts actually contribute to damaging your health. If you are extremely thirsty, quench it to your heart's content with safe drinking water. Don't drink excessive amounts of fruit juice or sodas. Don't be lured into going back for free refills of soda. Soda should be seen a treat to enjoy once in a while, not something to have with every meal.

Is "Close Enough" OK?

Does it matter if the cup you had wasn't exactly eight ounces?

It matters if you really want to meet your nutritional goals. It matters if you want to make sure what you are consuming is nutritionally adequate. And, yes, it matters if you want to reach weight and lean body mass goals, and you need to gain or lose weight.

Understanding where you are getting and not getting your calories and nutrients will make a difference in how you plan and proceed to achieve your goals. Part of changing one's daily food intake pattern is to acknowledge what your current dietary intake is and to become aware of the circumstances when eating and drinking take place.

A little bit more or little bit less will not make much of a difference. The problem is that many times the amounts are a lot more or a lot less. If you consider that being off by an excess of 100 calories a day will mean gaining 10 pounds a year, then you might as well call a cup eight ounces.

What about Counting Carbs?

Most cereals, desserts and other processed foods contain large amounts of carbohydrates.

"Carbohydrates" is another term for sugars. Carbohydrates are found naturally in fruit, starchy grains and vegetables, dairy products, and other foods.

Both simple and complex carbohydrates break down to become simple sugars. Simple sugars are foods like table sugar, cornstarch, honey, molasses, syrups, fruits, fruit juices, and sodas.

Other than calories, these carbohydrates don't usually contribute much in terms of nutrients and they can add up quickly. (Fruits and fruit juices are an exception.) If you are having high blood sugar, you especially want to watch the amount of simple sugars you consume.

Foods mostly or exclusively concentrated in sugars often contain no worthwhile nutrients, and are considered "empty calories" or "junk food."

One example of empty calories is soda. Twelve ounces of soda contains 39 grams of carbohydrate, that is 150 calories and 9 teaspoons of sugar. For most people, a soda once in a while is usually not a big deal. When make a habit of drinking soda every day, however, you could be setting yourself up for a nutritional problem.

Big fruit smoothie drinks sold in malls and other locations are another example of a problem. As these drinks contain fruit and sometimes protein, they are promoted to be healthy.

They certainly could contribute to your nutritional needs and fit into a healthy diet for some people, but for most people, the amounts served are excessive. These drinks range from more than 400 calories to almost 800 calories each with as little as 2 grams to as much as 25 grams of protein. They provide 75 to 135 grams of carbohydrates, which is equivalent to 18.5 to 33 teaspoons of sugar.

Some Helpful Links

Food Labeling and Nutrition:

USDA Nutrient Database:

Dietary Guidelines for Americans:

Center for Science in the Public Interest:

APLA Nutrition & HIV Program:

Marcy Fenton, M.S., R.D., is AIDS Project Los Angeles' HIV nutrition advocate. She can be reached at

This article has been reprinted at The Body with the permission of AIDS Project Los Angeles (APLA). This article was taken from APLA's Positive Living Newsletter.