Healthy Eating with HIV

1
Healthy Eating with HIV

• Stephanie DeMaio, RD
• St Michaels Hospital

2
Goals of good nutrition

• Optimize health status, immunity and quality of
  life
• Prevent deficiencies
• Achieve and maintain a healthy body weight
• Manage other issues (comorbities)
• Maximize medication effectiveness

3
Issues

• Gastro N/V/D
• Decrease food intake (anorexia)
• Fatigue/tired
• Taste changes
• Mouth pain
• Anemia

4

• Increased cholesterol/heart disease
• Diabetes
• High blood pressure/HTN
• Liver problems
• Obesity/underweight
• Lipodystrophy
• cancer

5
Unintentional weight loss

• Oral/GI problems
• Decreased ability to eat/no appetite
• Money problems
• Not absorbing the nutrients

6
Metabolic causes

• Decreases in CD4/VL
• Opportunistic infections
• Hormone issues
• Thyroid issues

7
obesity
8
waist

• Men 40 inches
• Women 35 inches
• What this means?

9
What to do

• Dietary interventions
• Decrease total/saturated fats
• Increase fibre
• Decrease simple sugars
• Increase Fruits and vegetables
• Small, frequent meals
• exercise

10
Diabetes/insulin issues

• Risks
• Overweight
• Family history
• Ethnicity
• Decreased activity
• HTN/CVD/GDM

11
Can medications cause problems

• cART
• Steroids
• hepatitis

12
Heart disease risks

• Age
• Family history
• Gender
• Weight
• HTN
• High LDL
• Diabetes
• Diet/exercise

13
Canadas food guide

• How to use it

14
Lipids

• Fatty substances that do not dissolve in water
• Fats are solid at room temperature
• Oils are liquid
• Made of carbon, hydrogen and oxygen (like
  carbohydrates)
• Much higher energy content (9kcal/g)

15
functions

• Most concentrated energy source
• Large amounts are stored as adipose (body fat)
• The more fat they store, the larger they grow
• Number doesnt increase, only the size

16
functions

• Provide essential nutrients, linoliec acid is
  essential from fatty fish and plants
• Transport fat soluble vitamins (ADEK)
• Cell membranes, hormones
• Spare the burning of protein for energy
• Keep in body heat
• Protect organs
• Fullness and taste good!

17
cholesterol

• Soft, waxy substance made by the liver in animals
  and humans
• Not found in plants
• Cell membranes and hormones

18
Functions of cholesterol

• Raw material for bile
• Precursor for vitamin D
• Sex hormone production

19
Good and bad cholesterol

• LDL-lousylow
• HDL-healthyhigh
• Good and bad fats

20
Heart disease risks

• Total fat intake
• Saturated fat
• High calorie intake
• Lack of exercise
• Smoking
• Dietary cholesterol

21
What diet can do to help

• Monounsaturated fats (good/healthy oils like
  olive and nuts)
• Polyunsaturated fats (good/healthy oils)
• Exercise
• Fibre (25-38g/day)
• Need (20-35 from fats)

22
Triglycerides

• Excess carbohydrates are stored this way
• They do not stick to artery walls
• Risk of clot formation

23
Sources of animal fat

• Meat fats
• Bacon
• Whole milk
• Butter
• Lard
• Cheese
• Cream
• Egg yolks

24
Plant sources

• Vegetable oils
• Margarines
• Chocolate
• Peanut butter
• Salad dressing
• Nuts, olives
• avocados

25
Reducing dietary fats

• Cut down on red meats (choose lean)
• Limit fat when cooking (1-2 tsp/meal)
• Make good restaurant choices
• Choose lower fat versions (cream cheese)
• Use healthy oils (canola, olive etc)
• Remove visible fats (white on meats)

26
Trans fat

• Hydrogenation
• Baked goods, some margarines
• Clog arteries

27
Omega 3

• Reduce stickiness in the blood
• Research in
• Brain, cancer, heart, arthritis
• Sources
• Flax, fish, walnuts, tofu, omega products

28

• Heart regulate heartbeat, decrease stickiness of
  blood
• Brain abundant in brain tissue, help with
  depression, dementia
• Cancer inhibit bad cell growth
• Combat inflammation arthritis

29
How to get it
30
Other ways to lower cholesterol

• Oats
• Flax
• Soy
• Plant sterols/stanols
• Nuts
• Fish
• Alcohol (moderation/watch calories)

31
fibre

• Cereals
• Fresh fruit and vegetables
• Whole grains

32
Lipodystrophy

• Metabolic and physical
• High Cholesterol (total)
• High TG
• Low HDL
• High LDL
• Glucose/blood sugar
• Body changes

33
What to do

• Soy/replace some animal protein
• Omega 3-2-6 grams/day, fish sources
• Fibre!!
• 4-6 servings of fruits and veggies
• Focus on cereals and legumes like beans
• Nuts (almonds and walnuts)

34
Complimentary/alternative health products

• Statistics Canada
• 1997 56
• 1999 70 or 4 population

35
Canadian Guidelines

• Regulatory body
• Drug vs. food
• Manufacturing practices phased in Jan. 1,
  2004-Jan. 1, 2006
• Herbs not necessarily standardized to meet new
  regulations
• http/www.hc-sc.gc.ca/hpfb-dgpsa/nhpd-dpsn/index_
  e.html

36
Common herbs/supplements in HIV

• St. Johns Wart
• Decreased appetite
• depression
• antiviral
• Not effective
• Unsafe with other antidepressants (SSRIS)

37
Common herbs/supplements in HIV

• Glutamine
• Wasting
• Diarrhea
• Improve overall immune function
• Safe
• Up to 40g/day

38
Common herbs/supplements in HIV

• Garlic
• Lipid lowering agent
• Antiviral/antiseptic
• Immune function
• Unsafe with HIV anti-retrovirals and is
  contraindicated

39
Common herbs/supplements in HIV

• Zinc
• Improve immune function
• Diarrhea
• Wasting/anorexia nervosa
• Safe TUL 40 mg/day
• Ineffective