Nutrition and HIV

Nutrition and the Immune System

Nutrition Suggestions for People Living with HIV

Nutrition Strategies and Common Problems

Nutrition and the Immune System

Good nutrition will help strengthen your immune system and keep it strong. Poor nutrition results in a weakened immune system. A weakened immune system results in infection and illness. Infection and illness may cause a decrease in your appetite and negatively affect your digestion and absorption of nutrients which, in turn, results in malnutrition and weight loss. More malnutrition and weight loss further weaken the immune system.⁴ This cycle of malnutrition and increased infection/illness can be avoided if you eat well. You do not need to take a college course in nutrition to learn how to eat well. A few simple facts and eating hints will help you in managing and meeting your proper nutrition.

What Your Body Needs

Proper nutrition is important to your everyday health and well-being. Your body is constantly working twenty-four hours a day, seven days a week. During the day your body is busy making energy to help your muscles work, eliminating waste, digesting food, regulating your body temperature and performing numerous other activities. At night when you are asleep your body continues to work but at a slower rate. In addition, specialized functions such as healing, growing, and replenishing are occurring.

Your body needs energy in the form of food to perform these functions. And, these functions require energy (calories) in the form of proteins, fats, and carbohydrates. In addition, the body requires certain substances such as vitamins, minerals and water (yes, water!) to help perform all its functions.

Your body becomes weak and susceptible to illness without high quality sources of food. Chronic illness like HIV-infection or an AIDS diagnosis places extra demands on your body and therefore requires that you pay special attention to the quality, variety, and quantity of food you eat.¹

Protein is vital to optimal health. All parts of your body need protein - the brain, heart, liver, kidney, muscles, etc. Proteins are made up of substances called amino acids. Amino acids are needed to help perform many of the biological functions in your body. Without them, these functions could not happen and very poor health or even death could occur. For example, protein is needed to make antibodies which help prevent infection and disease from microbes like bacteria. Proteins also transport oxygen and nutrients in the blood and are essential to the clotting of blood, the formation of scar tissue and muscle growth. When you do not eat adequate amounts of protein every day, these functions become impaired, and cells, tissues, and muscles are not replenished.

Lack of protein in the body results in catabolism. Catabolism is when the body begins to "break itself down" in order to get the nutrients it needs. It’s the body’s way of ensuring you stay alive. If you do not get enough protein, your body will undergo catabolism to keep your body’s biological functions running. You begin to lose muscle mass (wasting) since muscle tissue contains the most protein. Catabolism also weakens your immune system.

It is recommended that a person living with HIV or AIDS get between .8 grams to 1.0 gram of protein per pound of body weight.³ For example, if a person weighs 150 lb. he should get between 120 grams (.8x150) to 150 grams (1.0x150) of protein a day. Generally, one cup of a dairy product is equivalent to 8 grams of protein and one ounce of meat contains approximately 7 grams of protein. Product labels will also indicate amount of protein.

Protein can be found in meat, poultry, fish, eggs, seafood, beans (pinto, black, kidney, garbonzo, lentils and peas), diary products, and vegetables. Soy milk, tempeh, and tofu are also excellent sources of protein, especially if you don’t or are unable to eat animal sources of protein. You can also supplement your diet with protein shakes. Many of these commercial supplements are fortified with vitamins and minerals and are simple to prepare. They can be used to increase the protein in your diet, as a snack , or to supplement a meal.

Carbohydrates or "starches" are broken down in the body into a sugar called glucose. Glucose supplies the cells in your body energy in order to function. Carbohydrates are found in pasta, whole grains, cereal, rice, beans, lentils, peas, nuts, fruits, and vegetables.

Fats also supply the body with energy and help with the digestion of certain vitamins and minerals. There are saturated and unsaturated fats. Saturated fats are found primarily in animal products, and unsaturated fats are in both animal and vegetable products. Animal fats look gristly and can be seen on the outer edges of pork chops, steaks, and other red meats. Animal fat is also found in the skin of poultry such as chicken and turkey. Vegetable fats are found in nuts (almonds, peanuts, etc. ), seeds (safflower, sunflower, flax), and beans (soy). Because of our "body conscious" society, fats have received a bad "rap." In reality, the body needs fat. There are substances called "essential fatty acids" (EFAs) that are fats which help in certain biological functions and which help protect your body from harmful substances called "free radicals." Free radicals have been associated with cancer. EFAs are mostly found in nuts and seeds, especially safflower and flax seeds or oils.

Symptoms = .75 grams

Symptoms = 1.0 grams

Infections = 1.2 grams

Take 1 to 3 grams of vitamin C each day

Take up to 25 mg of zinc and 50 — 150 mcg of selenium

Vitamins and Minerals

Vitamins and minerals are necessary for proper bodily functions and disease prevention. Vitamin and mineral deficiencies can cause certain diseases and illnesses. For people with HIV it is recommended to take a daily broad-based multiple vitamin-mineral supplement. The key word here is supplement, not replacement. Vitamin and mineral supplements should not take the place of eating well. There are many compounds in food that are necessary to maintaining optimal health and are not found in supplements. A supplement pill which provides 100% to 200% of the recommended daily allowance is fine. In addition you may want to consider supplementing zinc and selenium, as research has shown that HIV-positive people tend to have zinc and selenium deficiencies. Do not take mega doses of vitamins without consulting your doctor and/or nutritionist. Due to their toxicity at high levels, mega doses of certain vitamins can result in side affects such as nausea, diarrhea, and headache, and may even interact with some of the prescribed medications you are taking.¹ Unfortunately, the science of supplementation and nutrition is new and further study is needed prior to making definitive therapeutic claims.

One thing you can’t have too much of is water. Your body uses a lot of water each day. Water helps to detoxify your body, assist with transport of nutrients and other substances, and regulate your body temperature and weight. Try to drink at least eight cups of water a day. It’s a good idea to avoid tap water whenever possible. If you are out hiking or in the wilderness, don’t drink the river water. The water may look "sparkling clean", but it is full of microbes that can wreak havoc on your gastrointestinal tract. If you have diarrhea, vomiting or fever drink plenty of water or other liquids like ginger ale, juice, broth, sports drinks (Gatorade), etc. to replace the fluids you lose when experiencing these symptoms.^1,2,

Calories refers to the term used to measure the energy in food. We need a minimum level of calories every day to maintain our body weight. The amount of calories necessary will vary from person to person, depending on their age, weight, physical activity, and health. To make sure you are getting enough calories eat four to six small, nutritiously sound meals a day or three medium sized meals with three to five healthy snacks. Nutritional liquid supplements (Ensure, Advera, etc.) can be used as snacks between meals or with a meal in order to boost your daily caloric goals. Talk to your nutritionist or doctor to recommend one to you.

A good way to make sure that you are eating a well-balanced diet is to eat a variety of fruits, vegetables, grains, meats and dairy products and to drink plenty of water. One source of food, no matter how nutritious it may be, will not give you all the essential nutrients for optimal health. A serving is usually a medium sized piece of fruit (pealed or washed) one slice of bread, 1/2 a bagel or muffin, five to eight crackers, two eggs cooked any style.¹ Read the nutrition labels on food items. The nutrition label will also indicate the amount of protein per serving. This can be helpful if you are trying to increase your protein uptake. Use the chart below to help you figure out a typical serving for common food items.^1,4

Serving Recommendations:

1. Fruits-- A Minimum of Four Servings a Day: for vitamins and minerals, fiber and carbohydrates

2. Vegetables-- A Minimum of Five Servings a Day: for vitamins and minerals, fiber, carbohydrates, and protein

3. Breads, cereals, pastas and grains (rice) -- A Minimum of Ten Servings a Day: for carbohydrates, fiber, protein, minerals and vitamins

4. Meat, poultry, and fish -- A Minimum of Three Servings a Day: for protein, fats, vitamins and minerals

5. Milk, cheese, and yogurt -- A Minimum of Three Servings a Day: for protein, fats, vitamins, and minerals

Cut and Washed Fresh Vegetables

Cooked beans, lentils or peas

Cooked Tofu or Tempeh

Cooked Pasta or Rice

Nutrition Suggestions for People Living with HIV^1,3,4

To make sure you are getting your necessary nutrients make your meals colorful. Red, green, orange, and yellow fruits and vegetables, and nuts should be a part of every meal. For example, instead of a simple iceberg lettuce and tomato salad, try a romaine and red leaf lettuce salad with walnuts, raisins, yellow crooked neck squash, carrots, red onions, sliced strawberries, spinach, roma tomatoes, and slices of pear, apple or nectarine. Toss this with your favorite dressing and enjoy! If you add some whole wheat bread and a cup of your favorite soup, you will have given yourself a meal that is loaded with protein, carbohydrates, vitamins, minerals, water and essential fatty acids.

Adding your favorite fruits, nuts and vegetables to your salad will ensure you get the vitamins, nutrients and calories you need

Make sure you get enough calories. If you do not eat enough food to meet your caloric requirements, you will start to lose weight, strength, and stamina.

Eat small frequent meals or healthy snacks throughout the day

Drink plenty of water and other healthy fluids like juice, soy and/or skim milk, non caffeinated drinks

Avoid coffee, tea, alcohol, and caffeinated soda, as they will cause you to lose more water through excessive urination

Take a multi vitamin and mineral supplement which meets 100% to 200% of the RDA

If you feel you need to increase your protein intake drink high protein shakes between meals. Soy protein isolate and Whey protein are excellent sources of protein and are easily absorbed and digested

Eat foods that you especially like

Invite friends over for meals, especially if you don’t feel like eating due to the "blues". Having friends around may lift your spirits and put you in the frame of mind to enjoy eating

If you are a vegetarian make sure you are eating a variety of foods which are naturally high in protein like tofu, tempeh, soy milk, beans and lentils, potatoes, and corn. Add protein to your soups, cereals, and other dishes by adding vegetable protein powder or flakes

Cook meals that will feed more than one person. You can freeze the leftovers in single serving sizes and thaw and re-heat them when you are not feeling up to cooking

Steam your vegetables instead of boiling them, this will help to retain their flavor and nutrients

If you don’t like vegetables, try spicing them up by sprinkling lemon, basil, thyme, or any of your other favorite spices, dips or sauces on them

Keep a food journal to keep track of what you are eating, after a week you can review it to see what you might want to change in order to eat more nutritiously

Avoid recreational drugs (speed, cocaine, pot, etc.), cigarettes, and alcohol; They place a lot of stress on the liver, kidneys, and other vital organs by making them work harder to detoxify They also negatively affect your metabolism by causing it to speed up. This causes you to use calories which you can not spare. These drugs also block natural biochemical signals which tell your brain you are hungry. If your brain is not able to receive these signals, you will skip meals and suffer from malnutrition and weight loss

Food Safety

Food safety must become a very important part of your life. You cannot be too cautious when it comes to food safety and handling. Preventing food-borne illnesses requires strict, habitual cleanliness.

You must take extra precautions to avoid getting sick because your immune system may not be working at full strength. For example:^2,3,1

Do not eat raw seafood (clams, shellfish, oysters or fish) - it should only be eaten after it has been cooked. Cook food thoroughly, especially meats and poultry, to make sure all of the micro-organisms (germs) have been killed. You don't want to run the risk of bacterial infections which may cause diarrhea or other intestinal illnesses.
After shopping for food, store the perishable items as soon as possible to avoid contamination. Don't let the frozen foods thaw out until you are ready to use them. It is best to thaw frozen foods in the refrigerator.
Wooden cutting boards tend to harbor bacteria. Use a surface such as plastic (lucite), which a knife's blade cannot cut.
Use a zip lock bag or an air tight wrap to keep foods fresh while stored in the refrigerator.

At the grocery store:

Buy your non-perishables first, produce second, and refrigerated and frozen foods third. Meats (including fish and poultry) are usually not well wrapped, and their juices can be contaminated with bacteria. Place meat where drippings cannot come into contact with other foods. This is also good to do when storing meats.
Buy only pasteurized milk and cheese.
Inspect food before buying it. Don't buy or eat bruised, soft, or discolored fruits or vegetables.
Don't buy anything in a damaged container or package.
Avoid foods that contain undercooked or raw meat or dairy products.
Check expiration dates on food at the grocery store before purchasing and at home before eating. If it is close to the expiration date, do not buy it. If it is past the expiration date, do not eat it.

At home:

Wash your hands thoroughly before handling, preparing, and eating food.
Store meat, poultry, and fish on the bottom shelf of your refrigerator so that their juices do not spill onto other foods. Never put cooked meat, poultry, or fish back on a plate or cutting board that contains raw juices.
Thaw meat or poultry in the refrigerator, not on the counter.
Be cautious about cutting, dicing, and slicing. You should cut the produce first and meats last. In all cases, wash your hands and cutting board vigorously with warm, soapy water.
Buy a meat thermometer and one for the refrigerator too. The refrigerator must be kept at 40° F or lower and the freezer at 0° or lower.
Wash your hands and utensils well and often. Use paper towels, instead of a dish-towel, to dry your hands and dishes. This will help prevent spreading germs.
Disinfect your dish-wash towels and sponges regularly by soaking them for a few minutes in a bleach solution made of 1 teaspoon of bleach to 1 gallon of water.
Wash or wipe down your cutting board and counter tops after cutting meat, poultry or fish with the bleach solution. Rinse your cutting board well.
Do not keep leftovers in the refrigerator for more than three days. You can safely keep them in a freezer for up to a month.
Eliminate anything made with raw eggs such as homemade egg nog, raw eggs in shakes, raw eggs in salad dressings, under-cooked custards, homemade mayonnaise, mousse, and other egg-containing foods.
Never eat raw meat, sushi, or sashimi. Raw meat, fish, and shellfish can be a source of bacterial contamination.
Keep hot food hot. Baked dishes should be kept at room temperature for no more than 30 minutes. Germs breed best at room temperature.
Never eat cheese with mold on it, nor cheeses made with mold like blue cheese or Roquefort. Avoid soft ripened cheeses like brie and Camembert.
Wash raw fruits and vegetables thoroughly. Use a vegetable brush and scrub the outer skins thoroughly or peal off the skin.
Avoid handling pets, pet feeding dishes, or pet toys while cooking and eating.
Avoid home made ice cream, home canned foods/preserves, and home smoked foods, since the risk of improper preparation is increased.

Nutrition Strategies for Common Problems^1,3,4

If you experience loss of appetite:
- try eating your favorite foods
- eat smaller meals throughout the day
- drink protein shakes, ice-cream malts, or supplement drinks like Ensure, etc. They aren’t very filling and provide calories and nutrients you need
- eat with friends-- this may make your eating experiences more pleasant
- eat snacks and other easy to prepare meals like frozen dinners, can soups. On days when your appetite is low, if the meals are easy for you to prepare you will be more likely to eat
- eat by the clock, instead of when you feel like eating. For example, decide that you will eat a small high calorie meal every two to three hours and use the clock as your cue to eat
- take advantage of any food cravings, for example if you feel like eating a burrito at eight o’clock in the morning then eat it

You must eat in order to maintain your strength, stamina, and weight. If your appetite continues to diminish, consult your doctor. He or she may be able to prescribe medications that will stimulate your appetite.

If you experience nausea:
- try dry foods like crackers or toast to calm your stomach
- avoid spicy and greasy foods which could make you feel worse
- you may find it easier to eat creamy, cold foods like pudding, ice-cream, frozen yogurt or icy foods like sherbet and popsicles
- eat small meals, nausea can be worse when the stomach is empty
- if you believe your medications are causing your nausea talk to your doctor. He or she may be able to time your dose as not to upset your stomach
If the smells associated with cooking foods upsets your stomach:
- eat cold cereal with fruit, raw vegetables, sandwiches, fruits and nuts
- get someone to cook your meals
- drink a protein shake
If you are experiencing diarrhea:
- drink plenty of fluids like water, juice, sports drinks, caffeine free soda (seven up, ginger ale)
- avoid tea, coffee and caffeinated sodas
- avoid alcohol
- do not skip meals, as you will need to replace the minerals, calories, and vitamins that you will be losing
- eat simple foods like crackers, plain pasta, rice, bananas, toast, hot cereals, canned peaches or other fruits, broth, Jell-O, and nectar drinks
- avoid foods with high fiber contents like raw vegetables, whole grain breads and cereals, fruits with skin as they may be irritating to your intestines while you have diarrhea
- avoid spicy and greasy foods

If cramps accompany your diarrhea avoid foods which cause gas such as beans, broccoli, cabbage, and cauliflower. If cramps or other severe pain accompanies your diarrhea or if the diarrhea gets worse, is bloody, or last more than five days contact your doctor. Unchecked diarrhea can cause serious dehydration and electrolyte imbalances. Your doctor can prescribe medications to avoid these from happening.

If you have trouble eating and/or swallowing due to sores or ulcers in your mouth or throat:
- avoid spicy foods
- avoid acidic foods like oranges, tomatoes, lemons, limes, grapefruits, pineapple, etc.
- eat soft, smooth foods like protein shakes, ice cream malts, rice and other puddings, bananas, pasta, cottage cheese, yogurt, macaroni and cheese, oatmeal, cream of wheat, etc.
- let your cooked food cool down before eating it
- eat soups like cream of chicken, cream of mushroom, New England clam chowder, cream of broccoli
- avoid foods that require a lot of chewing
- cut your food into tiny bit size pieces, to make chewing easier
- drink plenty of water
- gargle and rinse your mouth frequently with salt water or an antiseptic, a one to three ratio of hydrogen peroxide to water is a good gargle, expect some foaming with hydrogen peroxide. Rinse your mouth out with water after using the hydrogen peroxide solution. Do not swallow the gargle or mouth rinse!
If you are feeling too tired to cook:
- order take out
- have someone cook for you
- eat easy to prepare snacks like cheese and crackers, smoothies, malts, protein shakes, fresh or canned fruit, yogurt, cottage cheese, carrots, celery, etc.
- eat already prepared meals like frozen dinners, burritos, pot pies, etc.
If you have trouble digesting fatty foods:
- eat low fat foods
- avoid fried foods
- avoid lunch meats
- drink plenty of water

Changing Your Diet

Changing your diet may be one of the best things you can do to help you live a more healthy lifestyle. As explained early in this chapter, nutrition is very important to optimal health and optimal health is your goal. You must determine if your current eating habits support you and if not what you want to change. A good way to do this is to keep a food journal for a week to get a snapshot of your eating habits and the foods you eat (see Appendix for sample).⁴

Record in your food journal what you eat and drink and the time you eat. For example, an entry would read:

8:30 a.m. -- two scrambled eggs, 1 slice of toast w/ butter and jam, a glass of milk

12:30 p.m. -- Turkey Sandwich (two slices of wheat bread, 2 slices of Swiss cheese, 2 slices of turkey, lettuce, tomato, pickles and onions, mayonnaise and mustard), 1/2 cup of macaroni salad, a bowl of tomato soup (about 2 cups) and glass of juice (grape).

6:15 p.m. spaghetti and meatballs (full plate of spaghetti and six meatballs), salad (lettuce, tomato, chopped carrots, and red onions) with vinegar and oil dressing, three slices of French bread, a glass of water.

Two chocolate chip cookies and three scoops of vanilla ice cream.

2:15 p.m. -- 1 bag of Popcorn w/ butter and a soda

8:40 p.m. --Cheese and crackers ( about 10 crackers and ten bite size pieces of monteray jack cheese and a glass of orange juice

When making entries for vegetables guess whether it is a 1/2 cup, 1 cup, etc. Make sure to provide detail on what you eat. For example, a turkey sandwich to one person may be two slices of turkey and bread, yet to someone else it may include cheese, lettuce, tomato, sprouts, etc. A more accurate picture of your nutritional intake is provided by the detail you write in your Food Journal. The more detailed you can be the better. You may find it easier to make your entries right after you eat as opposed to the end of the day.

After a week, review the journal to see if you are eating:

a minimum of three protein servings: from fish, poultry, meat, beans, tofu, lentils, nuts, seeds, peas, etc.

a minimum of three protein servings: from dairy products like milk, cheese, yogurt, eggs, etc.

a minimum of ten carbohydrate servings: from breads and other baked goods, crackers, cereals, pastas, rice, etc.

a minimum of five servings of vegetables: broccoli, carrots, squash, cauliflower, beets, potatoes, corn, lettuce, spinach, cabbage, green beans, eggplant, etc.

a minimum of four servings of fruits: apples, oranges, pears, lemons, grapefruits, grapes, apricots, strawberries, plums, cantaloupe, honey dew melon, cherries, mangos, pineapple, etc.

Also review the journal to see:

what you drink and how much you drink

the size of the meals (large, small, medium)

what snack choices you make

This information will help you see if you are eating the minimum number of servings to sustain optimal health, whether you are eating enough, if what you are eating is healthy and nutritious, and if you are drinking plenty of water and other healthy fluids. Once you have reviewed the journal you can them decide if there are any changes you want to make.

If you decide to make changes, write down all the reasons why you want to make the changes. Changing one’s diet can be difficult, so this has to be something you want to do. If you can’t come up with any reasons why you want to change your diet, then it is not a good time to start this process. This is okay, because all change happens in time and on time. Remember, be gentle with yourself, you may not be ready yet.

When you feel and know you are ready to start, start off slow.⁴ Pick one thing to work on. It is best to pick something that will be easy for you to accomplish. For example, after reviewing your journal you may notice that there are several changes you would like to make. You may notice that you don’t eat enough, that your snack choices are mostly sweets, and that you very seldom drink water. If drinking more water is the easiest place to begin, then begin there or you may decide that you just want to eat more in general.

Once you have a starting point, you will develop a self-contract as outlined in Chapter One. Remember your contract should be specific. "I want to eat more" is not specific enough. You will need to plan out how you will accomplish eating more. This is a good time to get support from your health educator in planning out your objectives.

Changing your diet will require you to do some planning. For example, if you decided to "eat more" then you would want to plan how often, how much, when, and what you would be eating more of. The more specific you can be the more likely you will succeed. Let’s follow a patient, who we will call Carol, as she puts together her plan to eat more.

Carol decides she wants to change her eating habits. After reviewing the food journal she kept for a week, she identifies several things she would like to change and decides to start with "eating more." Carol then writes down her reasons for wanting to eat more. She comes up with the following list:

To give me control over my health

To have more energy to do the things I want to do

To maintain my weight

To feel better about doing something good for myself

To get the vitamins and calories my body needs to be well

To reduce my fatigue

Carol then sits down to write out her contract. She:

First, re-clarifies her goal

Goal: To eat more, so I don’t lose weight and will have more energy to do the things I want to do.

Second, she writes her specific weekly objective ( she uses the contract form in this manual)

Weekly Objective: Eat three healthy snacks a day. Eat one between breakfast and lunch, the second between lunch and dinner, and the third one to two hours before I go to sleep.

Carol then asks herself "Can I meet this contract?" She decides that she is "neutral" on her ability to meet it, so she adjusts it to read, "Eat two healthy snacks a day. Eat one in the morning at 11:00 a.m. while I watch the Price is Right and the second at 9:00 p.m. while I watch the Rosie O’Donnel Show."

Carol made these changes because she had to arrange her snacks around her Crixivan schedule. Carol takes her Crixivan at 7:00 a.m., waits an hour (as prescribed - one hour before or two hours after meals) then eats breakfast around 8:00 a.m. She tries to eat her lunch by 1:00 p.m. every day, since she needs to take her Crixivan at 3:00 p.m. (8 hours after her first dose, two hours after her meal). So, eating her snack at 11:00 a.m. would work well. Carol normally eats dinner around 6:00 p.m. and her last dose of Crixivan is at 11:00 p.m., so the latest she could eat a snack would be 9:00 p.m. She normally doesn’t eat after dinner, but since she faithfully watches the Rosie O’Donnel Show she figured this would be a good reminder to eat her second snack.

Carol felt more comfortable with the new objective and posted it on her refrigerator and television to remind her. The next step Carol did was to plan what she would eat for snacks by making a weekly menu (see Appendix for sample). She then went out and bought all the food she would need on hand to make her snacks.

Snack Ideas -- Be creative, experiment with different food textures and tastes

Peanut butter spread on celery, a medium sized cherry almond scone and juice, milk or water

Granola, walnuts and oats mixed in applesauce, a half a bagel with butter and a glass of soy/skim milk or juice/water.

Fruit Smoothie-- two cups of skim/soy milk, 1 large banana, 1/4 cup granola, several strawberries, 1 tablespoon of soy protein isolate. Mix in blender. Delicious!

Yogurt (stir in your favorite fruit, nuts or granola) and a fruit filled bar or raisin bread

1 medium sized apple (skin pealed) with some almonds, a couple of slices of cheese, some crackers and a glass of water

Carol checked off her objectives on her contract as she met them. She took notes on both her successes and barriers. After a few weeks, Carol found that her appetite and energy increased and she slowly started to make her other meals more nutritious and hearty. Carol was successful at managing her nutrition changes, and of course she rewarded herself by learning something she always wanted to learn...yoga.

Your successes will depend on your desire to change, your readiness, and your clarity about what you will be changing. Remember to start slowly. As you experience success with managing your nutrition program you will begin to wonder why you never ate better before. This is normal. Reward yourself for your success and keep moving forward.

If you experience problems, use the problem solving methods described in Chapter One to help you work around them and find solutions. Above all be patient and consistent in your practice, if you need assistance with changing your eating habits call the Owen Clinic Nutritionist at 543-3995 or Health Educator at 543-2680.

1. McMillan, Lisa, R.D., Jarvie, J., and Brauer, J. Positive Cooking: Cooking for People Living with HIV. Avery Publishing. 1997. pgs. 5-47.

2. "Eating Defensively: Food Safety Advice for Persons with AIDS." A video distributed by National AIDS Clearing House. FDA/CDC. 1989.

3. "Good Nutrition for People with HIV/AIDS." A video distributed by Bristol-Myers Squibb. 1995.

NUTRTION PRIORITIES	PROTEIN RECOMMENDATIONS PER POUND OF BODY WEIGHT	VITAMIN AND MINERAL RECOMMENDATIONS
Calories — if you do not eat enough food to meet your caloric needs you will start to lose weight and strength	HIV No Symptoms = .75 grams	Take a multi-vitamin one to two times a day
Protein — Protein helps support immune function. If you do not eat enough you could lose muscle mass and strength	HIV With Symptoms = 1.0 grams	Take one B-complex pill a day
Fluids — water is essential to help prevent dehydration and assist with bodily functions	HIV With Opportunistic Infections = 1.2 grams	Take 1 to 3 grams of vitamin C each day
		Take up to 25 mg of zinc and 50 — 150 mcg of selenium

Food Item	1/4 Cup	1/2 Cup	3/4 Cup	1 Cup	One Ounce	Three Ounces
Cheese					4
Cut and Washed Fresh Vegetables				4
Milk or yogurt				4
Dry Cereal				4
Cooked beans, lentils or peas				4
Cooked Tofu or Tempeh				4
Canned Fruit		4
Nuts		4
Cooked Pasta or Rice			4
Hot Cereal			4
Poultry or Fish						4
Red Meat or Pork						4

Breakfast	Lunch	Dinner
8:30 a.m. -- two scrambled eggs, 1 slice of toast w/ butter and jam, a glass of milk	12:30 p.m. -- Turkey Sandwich (two slices of wheat bread, 2 slices of Swiss cheese, 2 slices of turkey, lettuce, tomato, pickles and onions, mayonnaise and mustard), 1/2 cup of macaroni salad, a bowl of tomato soup (about 2 cups) and glass of juice (grape).	6:15 p.m. spaghetti and meatballs (full plate of spaghetti and six meatballs), salad (lettuce, tomato, chopped carrots, and red onions) with vinegar and oil dressing, three slices of French bread, a glass of water. Two chocolate chip cookies and three scoops of vanilla ice cream.
Mid-morning Snack	Mid-afternoon Snack	Evening Snack
10:45 a.m. -- apple	2:15 p.m. -- 1 bag of Popcorn w/ butter and a soda	8:40 p.m. --Cheese and crackers ( about 10 crackers and ten bite size pieces of monteray jack cheese and a glass of orange juice