We often hear the phrase ‘good nutrition’, but does anyone really know what it means? It’s one of those expressions that gets bandied about and we are all expected to understand its implications. Unfortunately, it’s often lost in translation.
We are constantly being bombarded with nutritional advice, fad diets and detox products. One day, carbohydrates are good for you and the next day they are not. No wonder it’s hard to take nutrition seriously!
Despite all this information, there is rarely nutrition advice specific for people with HIV. You can find bits and pieces if you look hard enough, but most of us are too busy enjoying our lives, so we eat what we want and hope for the best.
Defining good nutrition
Louise Houtzager is an accredited practising nutritionist at Sydney’s Albion Street Centre’s [6] Nutrition Development Division. She sat down with me to explain good nutrition and the importance of a balanced diet for people with HIV.
“Good nutrition is really just eating a variety of foods. While there are the five food groups in the Australian Guide to Healthy Eating, basically it’s about variety,” says Louise.
The Australian Guide to Healthy Eating [7] defines the foods you should eat each day to get the vitamins and nutrients you need to sustain your health and well-being. It redefines and simplifies the traditional healthy eating pyramid many of us grew up with, showing the proportion of each food group that you need to choose.
The key is making sure you have lots of different foods from each group throughout the week.
“You need at least 20 different healthy foods a day, rather than just eating from the different food groups,” Louise explains. “It’s really about variety within the groups, not just eating from each of the groups. You should try to have a lot of variety and limit your intake of processed foods.”
You need lots of different colours on your plate, like an artist’s palate, to make a good meal. If you do this, Louise says, you are bound to have the variety needed to provide the vitamins, minerals, proteins and carbohydrates you need for good nutrition.
The role of nutrition in HIV
With the great improvements we’ve seen from antiretroviral therapy (ART), it’s easy to forget some of the basic things we need to do to take care of ourselves. Most people on ART have undetectable viral loads and decent CD4 counts, and only experience the occasional side effects. So, do we really need to worry about nutrition as well? The short answer is yes.
“Nutrition is important for the immune system of all people, but particularly for people with HIV. If you have poor nutritional status as well as HIV, you have two things working together to reduce your body’s immunity and increase your susceptibility to infection. This is one of the main reasons nutrition is important for people with HIV,” explains Louise.
Your body needs nutrients to build and repair cells, regulate hormones, fight infection and maintain your energy levels. In addition, there is a lot of anecdotal evidence that suggests a healthy diet and good nutritional status will help you tolerate your HIV medicines better, maintain weight and muscle mass more easily and generally make you feel better about your overall health.
“Because people with HIV are living a relatively ‘normal’ lifespan, there are now more risks for other diseases that affect immunity and there are independent risk factors as well. For example, HIV is a risk factor for heart disease. If you have other risk factors like overweight, high cholesterol or insulin resistance (caused by poor nutrition) then that’s going to cause other health problems.”
So, it’s important to maintain good nutrition to keep your body and immune system strong to deal with these other risk factors.
“Good nutrition, together with ART, can really help build the immune system,” says Louise. “Your medicines won’t work well if your body is not well. You need good nutrition to have good outcomes on ART.”
It’s important to think of nutrition as part of your overall approach to managing HIV. You should consider your diet just as important as your medicines.
Eating well
It’s often hard to choose the right foods for a balanced, healthy diet and even harder to stick to one even if you’re armed with all the information.
For some of us, it’s about the time and effort involved, while for others, it’s the perceived expense of healthy eating or budget constraints that prevents us from eating well.
“Eating well is important and we often forget about that,” says Louise. “People need education about food affordability and where to access food, as well as budgeting help to prioritise nutrition.”
She stresses the need to try new foods and expand your diet. “Things like legumes are very cheap. For example, canned kidney beans or lentils are very cheap at about $1 a can. This can give you two meals high in protein, whereas if you buy red meat you are spending $20–30/kg.”
“Red meat and fish can be included in a healthy diet. If you have 2–3 serves of lean red meat a week, it is actually quite good as a source of iron. You should also add oily fish to your diet to get your Omega-3s,” adds Louise.
You can get fish into your diet quite easily with canned tuna or salmon, which has the same nutrients as fresh fish. You can eat it straight from the can, in sandwiches or tossed through pasta. Canned salmon in particular is a good source of Omega-3 and you can often pick it up on sale.
When you buy canned fish, read the labels and check out the oil content. “If it is says olive oil or canola oil then that’s fine. It’s better to look for those in natural brine or spring water if you want to keep your kilojoule intake down.”
The key to incorporating red meat in your diet is portion control. The old model of half a plate of meat and some token vegetables has proven to be unhealthy. Louise offers a good tip, “Half of your plate should be coloured vegetables and the other half should be split between carbohydrates and proteins.”
And, if you are vegetarian, Louise warns, you can’t just take the meat off the plate. You need to replace meat with other sources of protein and iron, such as legumes or nuts, and include vegetables high in vitamin C like tomatoes and capsicum to help iron absorption from plant sources of protein. Wholegrain cereals are a great source of energy and B vitamins.
Protein is essential to help build muscle tissue and fight off infections, as well as to keep your heart and lungs in peak condition. However, Louise believes it’s a myth that people with HIV need to have a high protein diet.
“You only need to have adequate energy and, in terms of metabolism in asymptomatic people, you only need to have 10% extra calories, so there are no extra energy requirements unless you are symptomatic or have advanced disease, then you may need 20-30% more kilojoules per day.”
Treating yourself
If you look at the healthy eating guide, you’ll see everyone’s favourite in the lower right corner. Yes, it’s the meat pie, chips, crisps, ice cream, biscuits and the like. You’ll be pleased to know that you can have these in moderation and it is ok to indulge now and then, as long as it is not the main focus of your eating.
“If a person is only eating from one area, I tell them that initially they should try to incorporate some of these other things into their diet and gradually add more and more.
“For most people, depending on their weight, one or two extra items a day is alright in moderation, but they should be in addition to the healthy items. For example, a piece of fruit, as well as a scoop of ice cream, or a glass of milk with a small piece of chocolate.”
It’s all about getting the right balance and not beating yourself up for the occasional treat.
Getting started
It might seem like a bit too much to take in all at once. But, you can make slow, incremental steps to improve your nutrition and there are lots of people willing to help you get started.
The Nutrition Development Division at Albion Street Centre [6] provides free nutrition consultations for people with HIV and/or Hep C. You’ll be supported with information on oral health, understanding food labels, choosing the best foods when eating out and food preparation. You can even attend a small group supermarket tour to learn how to shop on a budget.
ACON’s Healthy Life Plus [8] program is a free, three-month program that provides people with HIV access to nutrition and fitness advice, and includes a free temporary membership to Gold’s Gym. You can read about Robbie’s success with this program here [9].
The Positive Living Centre [10] (PLC) and the Bobby Goldsmith Foundation [11] (BGF) are also great sources of support and advice. PLC offers seasonal cooking classes and community dietitians are available to provide nutritional advice. It has also introduced healthy options for its Tuesday breakfast service (10am to 12pm) and a chef is on hand to teach you how to prepare your own healthy breakfast.
Now, it’s just up to you to make the first step!
Affordable healthy meals
For cheap, healthy meals, Louise advises to start with carbohydrates such as pasta, rice or wholegrain breads and add lots of vegetables and a moderate serve of protein such as lean red meat, fish or legumes. You can flavour this with low-fat sauces, herbs and spices. If you base your diet on carbohydrates and plant-based foods, you can save money and ensure good nutrition. Some other top tips include:
• Buy lean red meat or poultry when it is on sale or buy in bulk. You can divide this into smaller portions and freeze it.
• Buy fresh fruit and vegetables in season, this will save you money and ensure freshness.
• Get your fruit and vegetables at markets such as Paddy’s Markets [12] in Sydney. You can save up to 40% on some things.
• When you go to markets, take a friend because they sell in bulk. You can pull resources, say $10 each, and you will get more than enough for a week.
• The Food Distribution Network [13] delivers fresh fruit and vegetables to your home at wholesale prices (you must meet intake criteria).
• Keep it simple. A cheap, nutritious meal, could be as simple as pasta with a few fresh vegetables with a tin of tuna or salmon mixed through. Stir frying vegetables with tofu or lean meat also makes a quick, affordable meal.
Resources
Albion Street Centre [14]
Tel: 02 9332 9600
Bobby Goldsmith Foundation
[15]Tel: 02 9283 8666 or 1800 651 011
Dieticians Association of Australia
[16]
Food Distribution Network [13]
Tel: 02 9699 1614
The Luncheon Club [17]
Tel: 02 8399 3220
Nutrition Australia [18]
Tel: 02 4257 9011
Positive Living Centre [10]
Tel: 02 9699 8756