Diet for PLHIV's?

Posted by Pozziepinoy on 2:08 PM
Hi,

I just want to ask about what to eat if you have HIV. Can you give me a menu for breakfast, lunch and dinner for typical Pinoy like me? I'm not really cooking but I'm willing to cook and follow instructions for my diet. I hope you can give me recipes that have available ingredients in our local market because I'm not really familiar with herbs and spices.
I hope you can help me please.

Sincerely,
XXX


CONTRIBUTOR'S RESPONSE

Hi XXX,

Thank you for your email and reading this blog.  You haven’t stated whether you are on ARV, what ARVs you’re on, or not or whether you are overweight or underweight.  Consequently my reply to your query is very long.  Given this, it was quite impractical for me to try to construct a menu for breakfast, lunch and dinner.  The only person who can do that effectively in any case is your HIV Medical Specialist or Dietician/HIV nurse.   However, the following are some general rules for a variety of nut uncommon situations that HIV+ people find themselves in.


Do I need a special diet?

There are no special diets, or particular foods, that will give your immune system an extraordinary boos on their own.  However, there are things you can do to keep your immunity up.
If you are underweight--or you have advanced HIV disease, high viral loads, or opportunistic infections--you should include more protein and extra calories (in the form of carbohydrates and monounsaturated and polyunsaturated fats).
However, being overweight puts extra stress on your body and increases the risk of heart disease, high blood pressure, and diabetes.


How do I keep from losing weight?

People with HIV often do not eat enough because:
  • HIV and HIV medicines may reduce your appetite, make food taste bad, and prevent the body from absorbing food in the right way
  • Symptoms like a sore mouth, nausea, and vomiting make it difficult to eat
  • Fatigue from HIV or the medicines may make it hard to prepare food and eat regularly
Weight loss is a common problem for people infected with HIV, and it should be taken very seriously. Weight loss can be caused by HIV-related infections or conditions or by untreated HIV itself.  Losing weight can be dangerous because it makes it harder for your body to fight infections and to get well after you're sick.  HIV/AIDS patients who lose more than 10 percent of their baseline weights are suffering from "wasting syndrome."  This often comes accompanied with other symptoms such as fever and chronic diarrhea.  Over 20 percent of people with AIDS suffer from wasting syndrome. Preventing, stopping and treating wasting is essential to restore well-being and slow down disease progression.  If HIV+ people experience wasting, they become more susceptible to infections and disease and the risk of mortality increases.

One of the first steps to prevent wasting is to work with a dietitian or HIV Medical Specialist to create an appealing diet that is also high in calories. The diet should include any foods that the patient enjoys eating and do not cause any side effects such as vomiting or diarrhea.  Although nutrition is essential, preventing further weight loss is also a key to stopping wasting.   At least 20 percent of the calories consumed every day should be protein.  People who are suffering from wasting should also increase their calorie intakes significantly.  Experts recommend up to 60 calories per kilogram of weight. This means a person, who weighs 65 kg, or 143 lbs., could need up to 3,900 calories per day.  You may struggle with getting enough calories and meeting your nutritional needs due to complications such as a decreased appetite, nausea, or sores in your mouth or throat.  To get enough calories, you may need to puree some foods so that the texture is soft enough so as not to cause irritation.  You may also need to have other people prepare foods to avoid nausea from the smells.  Eating small, frequent amounts throughout the day can sometimes help increase overall intake.
Adding protein to your diet

Protein-rich foods include meats, fish, beans, dairy products, and nuts. To boost the protein in your meals:


  • Spread nut butter on toast, low trans fat crackers, fruit, or vegetables.
  • Add cottage cheese to fruit and tomatoes.
  • Add canned tuna to casseroles and salads.
  • Add shredded cheese to sauces, soups, omelets, baked potatoes, and steamed vegetables.
  • Eat yogurt on your cereal or fruit.
  • Eat hard-boiled (hard-cooked) eggs. Use them in egg-salad sandwiches or slice and dice them for tossed salads.
  • Add diced or chopped meats to soups, salads, and sauces.
  • Add dried milk powder or egg white powder to foods (such as scrambled eggs, casseroles, and milkshakes).
Adding calories to your diet
The best way to increase calories is to add carbohydrates and some extra fat to your meals.
Carbohydrates include both starches and simple sugars.
Starches are in:


  • Whole meal and whole grain Breads, and muffins, low trans fat biscuits and crackers
  • Oatmeal and cold cereals
  • Whole meal Pasta
  • Brown Rice
  • Simple sugars are in:
  • Fresh or dried fruit (eg, raisins, dates, apricots, etc)
  • Jelly, honey, and maple syrup added to cereal, and whole meal pancakes
  • Fats are more concentrated sources of calories. Add moderate amounts of the following to your meals:
  • Butter, soft spreadable margarine that is marked low in trans fats, sour cream, cream cheese, peanut butter
  • Gravy, sour cream, cream cheese, grated cheese
  • Avocados, olives, salad dressing


How can I maintain my appetite?


When you become ill, you often lose your appetite. This can lead to weight loss, which can make it harder for your body to fight infection.
Here are some tips for increasing your appetite:

  • Try a little exercise, such as walking or doing yoga. This can often stimulate your appetite and make you feel like eating more.
  • Eat smaller meals more often. For instance, try to snack between meals.
  • Eat whenever your appetite is good.
  • Do not drink too much right before or during meals. This can make you feel full.
  • Avoid carbonated (fizzy) drinks and foods such as baked beans. These foods and drinks can create gas in your stomach and make you feel full and bloated.
  • Eat with your family or friends.
  • Choose your favorite foods, and make meals as attractive to you as possible. Try to eat in a pleasant location. 

Click on this link for a healthy and easy to prepare Filipino Fish recipe known as Sarciadong Isda.  http://www.filipino-food-recipes.com/sarciado.html
Being overweight puts extra stress on your body and increases the risk of heart disease, high blood pressure, and diabetes Before you begin your weight loss program, you should discuss your plans for weight reduction with your HIV care provider.    
A study in HIV showed that those who consumed larger amounts of soluble fiber tended to have fewer problems with weight gain.  Soluble fiber slows down the absorption of simple carbohydrates and may improve insulin sensitivity.  Foods with high amounts of soluble fiber include Whole Grains, Legumes seeds and nuts and Vegetables.

 Whole Grains.

 Oats are the grain with the highest level of soluble fiber. Eating 1/2 cup cooked oat bran or oatmeal for breakfast is an easy way to slip in that soluble fiber, especially when mixed with a fruit also high in soluble fiber. Barley is another grain with high amounts of soluble fiber that can be cooked as a cereal as well.  Flax seed is another.

 Legumes seeds and nuts. 

 Legumes are, hands down, the best source of soluble fiber and 1/2 cup of cooked legumes can provide as much as three pieces of fruit. While lima and kidney beans are the highest ranking, pinto, navy, black and northern beans trail behind at a close second.

Lentils, whether yellow, green. or orange, have as much soluble fiber as a piece of fruit or cup of oats, but far more overall fiber. Chick peas and black eyed peas also meet this criteria.

Tip: Eating just 1 Tbsp. of ground psyllium seeds can provide more fiber than any legume, grain, fruit or vegetable available. This is often found in products such as Metamucil.

 Fruits.

 Prunes, pears and citrus fruits like oranges contain the highest levels of soluble fiber of the fruits. Other fruits in this category include nectarines, peaches, plums, apples, bananas and blackberries. The good news with fruit is there are many ways to eat it. Mixing a few favorites together to create a smoothie may be a simple way to increase soluble fiber intake and would be loved by both young and old alike. Chopping up some fruits and mixing them with a low-fat yogurt (and oat-packed granola) makes a healthy meal, great for soluble fiber intake.  Just taking along a piece of fruit to eat when hungry for a snack may be just the fast food Nature intended.
Vegetables.

 While there is not a large list of vegetables that are high in soluble fiber, broccoli, brussels sprouts, and carrots make the list of veggies that are good for your heart and your digestive system.

Trans fat and cholesterol. 

 Doctors worry about trans fat because of its unhealthy effect on your cholesterol levels — increasing your LDL and decreasing your HDL cholesterol. There are two main types of cholesterol:
  • Low-density lipoprotein (LDL). LDL, or "bad," cholesterol transports cholesterol throughout your body. LDL cholesterol, when elevated, builds up in the walls of your arteries, making them hard and narrow.
  • High-density lipoprotein (HDL). HDL, or "good," cholesterol picks up excess cholesterol and takes it back to your liver.





Although small amounts of trans fat occur naturally in some meat and dairy products, it's the trans fats in processed foods that seem to be more harmful.  Commercial baked goods — such as crackers, cookies and cakes — and many fried foods, such as doughnuts and french fries — may contain trans fats. Shortenings and some hard margarines can be high in trans fat.  How do you know whether food contains trans fat? Look for the words "partially hydrogenated" vegetable oil. That's another term for trans fat.  It sounds counterintuitive, but "fully" or "completely" hydrogenated oil doesn't contain trans fat.  Fast food is loaded with trans fat. Any fried foods you get from these restaurants, like french fries, chicken nuggets, fried chicken or desserts are likely to be cooked in hydrogenated oils, which means trans fat overload. Foods that are not fried could also contain trans fat, such as pancakes and biscuits, because of butter-like products used to flavor them. If a restaurant claims they do not use hydrogenated oils, it doesn't mean your food is tans fat free. Foods can be prepared at the factory with trans fats, including being pre-cooked in hydrogenated oils before they arrive at the restaurant.  Desserts and snack foods that typically have a long shelf life without needing refrigeration are usually high in trans fat. This is because hydrogenated oils don't go rancid the way other oils do, which increase the shelf life of foods. Prepackaged snack cakes, snack pies, brownies, cookies and potato chips are all sources of trans fat. Read the labels and avoid foods with the words "hydrogenated oil" or "partially hydrogenated oil" in the ingredients list.  The same theory about shelf life in snack foods applies to processed meals. Frozen dinners, boxed meals and canned soups or stews commonly contain trans fats and hydrogenated oils. Baking and pancake mixes, frozen pies, refrigerated biscuits, bread, crackers and Ramen noodles are all examples of processed foods that contain trans fats and hydrogenated oils. Look for brands that claim to be trans-fat free, then double check with the ingredient list. 
1. Spreads. Margarine is a twisted sister -- it's loaded with trans fats and saturated fats, both of which can lead to heart disease. Other non-butter spreads and shortening also contain large amounts of trans fat and saturated fat:
  • Stick margarine has 2.8 grams of trans fat per tablespoon, and 2.1 grams of saturated fat.
  • Tub margarine has 0.6 grams of trans fat per tablespoon, and 1.2 grams of saturated fat.
  • Shortening has 4.2 grams of trans fat per tablespoon, and 3.4 grams of saturated fat.
  • Butter has 0.3 grams of trans fat per tablespoon, and 7.2 grams of saturated fat.
Tip: Look for soft-tub margarine, because it is less likely to have trans fat. Some margarines already say that on the packaging.
[Important note: When you cook with margarine or shortening, you will not increase the amount of trans fat in food.  Cooking is not the same as the hydrogenation process. "Margarine and shortening are already bad, but you won't make them any worse."]

 2. Packaged foods. Cake mixes, Bisquick, and other mixes all have several grams of trans fat per serving.  Tip: Add flour and baking powder to your grocery list and do your own baking or watch for reduced-fat mixes.
3. Soups. Ramen noodles and soup cups contain very high levels of trans fat.  Tip: Get out the crock-pot and recipe book. Or try the fat-free and reduced-fat canned soups.

4. Fast Food. Bad news here: Fries, chicken, and other foods are deep-fried in partially hydrogenated oil. Even if the chains use liquid oil, fries are sometimes partially fried in trans fat before they're shipped to the restaurant. Pancakes and grilled sandwiches also have some trans fat, from margarine slathered on the grill.
Examples:
  • Fries (a medium order) contain 14.5 grams.
  • A KFC Original Recipe chicken dinner has 7 grams, mostly from the chicken and biscuit.
  • Burger King Dutch Apple Pie has 2 grams.
Tip: Order your meat broiled or baked. Skip the pie. Forget the biscuits. Skip the fries -- or share them with many friends.
5. Frozen Food. Those yummy frozen pies, pot pies, waffles, pizzas, even breaded fish sticks contain trans fat. Even if the label says it's low-fat, it still has trans fat.
Mrs. Smith's Apple Pie has 4 grams trans fat in every delicious slice.
Swanson Potato Topped Chicken Pot Pie has 1 gram trans fat.
Banquet Chicken Pot Pie has no trans fat.
Tip: In frozen foods, baked is always heart-healthier than breaded.  Even vegetable pizzas aren't flawless; they likely have trans fat in the dough. Pot pies are often loaded with too much saturated fat, even if they have no trans fat, so forget about it.

 6. Baked Goods. Even worse news -- more trans fats are used in commercially baked products than any other foods. Doughnuts contain shortening in the dough and are cooked in trans fat.
Cookies and cakes (with shortening-based frostings) from supermarket bakeries have plenty of trans fat. Some higher-quality baked goods use butter instead of margarine, so they contain less trans fat, but more saturated fat.
Donuts have about 5 grams of trans fat apiece, and nearly 5 grams of saturated fat.
Cream-filled cookies have 1.9 grams of trans fat, and 1.2 grams of saturated fat.
Pound cake has 4.3 grams of trans fat per slice, and 3.4 grams of saturated fat.
Tip: Get back to old-fashioned home cooking again. If you bake, use fat-substitute baking products, or just cut back on the bad ingredients.  Don't use the two sticks of butter or margarine the recipe calls for two. Try using one stick and a fat-free baking product.

 7. Chips and Crackers. Shortening provides crispy texture. Even "reduced fat" brands can still have trans fat. Anything fried (like potato chips and corn chips) or buttery crackers have trans fat.
  • A small bag of potato chips has 3.2 grams of trans fat.
  • Nabisco Original Wheat Thins Baked Crackers have 2 grams in a 16-cracker serving.
  • Sunshine Cheez-It Baked Snack Crackers have 1.5 grams per 27 crackers.

Tip: Think pretzels, toast, pita bread. Actually, pita bread with a little tomato sauce and low-fat cheese tastes pretty good after a few minutes in the toaster oven.

 8. Breakfast food. Breakfast cereal and energy bars are quick-fix, highly processed products that contain trans fats, even those that claim to be "healthy."
  • Kellogg's Cracklin' Oat Bran Cereal has 1.5 grams per 3/4 cup serving.
  • Post Selects Great Grains has 1 gram trans fat per 1/2 cup serving.
  • General Mills Cinnamon Toast Crunch Cereal has 0.5 grams per 3/4 cup serving.
  • Quaker Chewy Low Fat Granola Bars Chocolate Chunk has 0.5 grams trans fat.

Tip: Whole-wheat toast, bagels, and many cereals don't have much fat. Cereals with nuts do contain fat, but it's healthy fat.

 9. Cookies and Candy. Look at the labels; some have higher fat content than others. A chocolate bar with nuts -- or a cookie -- is likely to have more trans fat than gummy bears.
Nabisco Chips Ahoy! Real Chocolate Chip Cookies have 1.5 grams per 3 cookies. If you plow through a few handfuls of those, you've put away a good amount of trans fat.

Tip: Gummy bears or jelly beans win, hands down. If you must have chocolate, get dark chocolate -- since it's been shown to have redeeming heart-healthy virtues.

10. Toppings and Dips. Nondairy creamers and flavored coffees, whipped toppings, bean dips, gravy mixes, and salad dressings contain lots of trans fat.

 Tip: Use skim milk or powdered nonfat dry milk in coffee. Keep an eye out for fat-free products of all types. As for salad dressings, choose fat-free there, too -- or opt for old-fashioned oil-and-vinegar dressing. Natural oils such as olive oil and canola oil don't contain trans fat.

 Can you eliminate trans fats entirely your diet? Probably not. Even the esteemed National Academy of Sciences has stated that such a laudable goal is not possible or realistic.  Instead, take this suggestion from Cindy Moore, MS, RD, director of nutrition therapy at the Cleveland Clinic Foundation:  "The goal is to have as little trans fat in your diet as possible.  "You're not eliminating trans fats entirely, but you're certainly cutting back."

Click the following links for a list of nutritious Filipino foods and a yummy tuna recipe:
  http://www.streetdirectory.com/food_editorials/cuisines/asian_food/filipino_recipes_for_the_weight_conscious.html   http://www.livestrong.com/article/317487-nutritious-filipino-foods/
How much water do I need?
Drinking enough liquids is very important when you have HIV. Fluids transport the nutrients you need through your body.
Extra water can:

  • Reduce the side effects of medications
  • Help flush out the medicines that have already been used by your body
  • Help you avoid dehydration (fluid loss), dry mouth, and constipation
  • Make you feel less tired
  • Many of us don't drink enough water every day. You should be getting at least 8-10 glasses of water (or other fluids, such as juices or soups) a day.
  • Here are some tips on getting the extra fluids you need:
  • Drink more water than usual. Try other fluids, too, such as Gatorade.
  • Avoid alcohol.
  • Begin and end each day by drinking a glass of water.
  • Suck on ice cubes and popsicles.

Note: If you have diarrhea or are vomiting, you will lose a lot of fluids and will need to drink more than usual.


What should I know about food safety?
Paying attention to food and water safety is important when you have HIV, because your immune system is already weakened and working hard to fight off infections.
If food is not handled or prepared in a safe way, germs from the food can be passed on to you. These germs can make you sick.

 You need to handle and cook food properly to keep those germs from getting to you.
Here are some food safety guidelines:

  • Keep everything clean! Clean your counters and utensils often.
  • Wash your hands with soap and warm water before and after preparing and eating food.
  • Check expiration dates on food packaging. Do not eat a product if its expiration date has passed.
  • Rinse all fresh fruits and vegetables with clean water before eating.
  • Thaw frozen meats and other frozen foods in the refrigerator or in a microwave. Never thaw foods at room temperature. Germs that grow at room temperature can make you very sick.
  • Clean all cutting boards and knives (especially those that touch chicken and meat) with soap and hot water before using them again.
  • Make sure you cook all meat, fish, and poultry "well-done." You might want to buy a meat thermometer to help you know for sure that the meat is fully cooked. Put the thermometer in the thickest part of the meat, not touching a bone. Cook the meat until it reaches 165-212 degrees F. on the thermometer.
  • Do not eat raw, soft-boiled, or "over easy" eggs, or Caesar salads with raw egg in the dressing. This includes eating uncooked cookie dough or cake batter that contains uncooked eggs.
  • Do not eat sushi, raw seafood, or raw meats, or unpasteurized milk or dairy products.
  • Keep your refrigerator cold, set no higher than 40 degrees F. Your freezer should be at 0 degrees.
  • Refrigerate leftovers at temperatures below 40 degrees F. Do not eat leftovers that have been sitting in the refrigerator for more than 3 days.
  • Keep hot items heated to over 140 degrees F, and completely reheat leftovers before eating.
  • Throw away any foods (like fruit, vegetables, and cheese) that you think might be old. If food has a moldy or rotten spot, throw it out. When in doubt, throw it out.
  • Some germs and parasites are spread through tap water. If your public water supply isn't totally pure and you have advanced HIV, it may be advisable to drink bottled or filtered water until your immune system gets stronger.

Can diet help ease side effects and symptoms?
Many symptoms of HIV, as well as the side effects caused by HIV medicines, can be alleviated by using (or avoiding) certain types of foods and drinks.
Below are some tips for dealing with common problems facing people living with HIV. You should also look in the Side Effects section for more information.

Nausea

  • Try the BRATT diet (bananas, rice, applesauce, tea, and toast).
  • Try some ginger--in tea, ginger ale, or ginger snaps.
  • Don't drink liquids at the same time you eat your meals.
  • Eat something small, such as crackers, before getting out of bed.
  • Keep something in your stomach; eat a small snack every 1-2 hours.
  • Discuss with your care provider how best to take your medications to avoid nausea--some HIV medicines (for example, many, protease inhibitors) should be taken on a full stomach, whereas others (for example, Efavirenz) should be taken on empty stomach.

Avoid foods such as the following:

  • Fatty, greasy, or fried foods
  • Very sweet foods (candy, cookies, or cake)
  • Spicy foods
  • Foods with strong odors

Mouth and swallowing problems

  • Avoid hard or crunchy foods such as raw vegetables.
  • Try eating cooked vegetables and soft fruits (such as bananas and pears).
  • Avoid very hot foods and beverages. Cold and room temperature foods will be more comfortable to your mouth.
  • Do not eat spicy foods. They can sting your mouth.
  • Try soft foods such as mashed potatoes, yogurt, and oatmeal.
  • Also try scrambled eggs, cottage cheese, macaroni and cheese, and canned fruits.
  • Rinse your mouth with water. This can moisten your mouth, remove bits of food, and make food taste better to you.
  • Stay away from oranges, grapefruit, and tomatoes. They have a lot of acid and can sting your mouth.

Mild Diarrhea

  • Try the BRATT diet (bananas, rice, applesauce, tea, and toast).
  • Keep your body's fluids up (hydrated) with water, Oral Rehydration Solution, or other liquids
  • Limit sodas and other sugary drinks.
  • Avoid greasy and spicy foods. High-fat foods can make diarrhea worse in some situations.
  • Avoid milk and other dairy products.
  • Eat small meals and snacks every hour or two.
  • Talk to your provider about medicines you are taking that may cause diarrhea and how to minimize this--for example, taking protease inhibitors with food may reduce medication-associated diarrhea.


Points to remember


  • You may feel that many things are out of your control if you have HIV. But you can control what you eat and drink, and how much. Good nutrition is an important part of your plan to stay well.
  • Eating right can make your body and your immune system stronger.
  • When you are HIV-positive, you may need to eat more. Be sure to eat a diet that is high in proteins and calories.
  • Exercise can stimulate your appetite and make you feel like eating more.
  • Drink plenty of liquids to help your body deal with any medications you are taking. If you are vomiting or have diarrhea, you will need to drink more than usual.
  • Practice food safety. Keep your kitchen clean, wash foods, and be careful about food preparation and storage. If your tap water isn't pure, drink bottled water.
  • You can use certain foods and beverages to help you deal with symptoms and side effects.
  • Before taking vitamin and mineral supplements, check with your health care provider.
  • Remember, there is no one "right" way to eat. Eating well means getting the right amount of nutrients for your particular needs. Your doctor may be able to refer you to a dietitian or nutritionist who can help design a good diet for you or may held design one with you themselves.
Do I need supplements?
Generally speaking no.  Always discuss supplements with your HIV Medical Specialist before adding them to your diet as they are metabolized by the liver and can interact with many types of ARV as well as potentially leading to liver toxicity. The best way to increase any vitamins and minerals you perceive you may have a shortage of is to increase your intake of foods rich in the nutrients your HIV Medical Specialist or dietician recommends unless they recommend you to do otherwise. Useful nutrients include vitamins A, C and E, which are abundant in fruits and vegetables. B vitamins, as well as selenium and zinc, are also important. Animal products, including meats, dairy and eggs are rich in these nutrients, as are sesame seeds and pumpkin seeds.



Vitamins and minerals that affect the immune system


What to do when starting ARV

It is a frequent response to learning your HIV+ and starting ARV. Do NOT stop your ARV if rashes develop without first consulting your HIV Medical Specialist. Mild rashes are to be expected at first as are mild fatigue, even if you're getting adequate sleep and exercise, and sluggishness. These tend to be fairly common when people first start ARV. They usually pass within the first 4 weeks or so.

 However, if the rashes become severe and are accompanied by a fever then see your HIV Medical Specialist ASAP as these can be signs of liver toxicity.

 Also; if you start to emit a strange body odor and/or bad breath; a change on skin color to pale white or has a tinge of orange/yellow; pain/tenderness in the Upper Right Abdomen so that if palpating (feeling) directly beneath the rib cage on the right side of the abdomen produces tenderness; stool changes such as small squibs of grey or light brown excrement which sinks in the toilet, these are all signs of liver toxicity.

 You DIET should limit, or exclude alcohol for the first 4 weeks at least, or until you are stable on your ARV.  Eat plentiful amounts of fruits and vegetables, especially dark green leafy vegetables and orange and red colored fruits and vegetables. Cut down on fats that may put a lot of stress on the liver, such as dairy products, processed vegetable oils (hydrogenated fats),  trans fats,deep fried foods, foods that are not fresh and contain rancid fats, preserved meats and fatty meats. Concentrate on eating "good fats" which contain essential fatty acids.  These are found in cold pressed vegetable and seed oils, avocados, fish, flaxseed, raw nuts and seeds (must be fresh) and legumes. Not only are good fats believed to be easier for the liver to process, they can help build healthy cell membranes around the liver cells.  Do your best to avoid artificial chemicals and toxins such as insecticides, pesticides, artificial sweeteners (especially aspartame), and preservatives.  You should also be careful regarding the coffee you drink. Many nutritionists recommend no more than two cups a day and should be brewed from ground natural coffee, not instant coffee powders. A recent study, however, suggested that moderate coffee intake actually had positive effects on the liver.  Consume a diverse range of proteins from grains, raw nuts, seeds, legumes, eggs, seafood, and if desired, free range chicken and lean fresh red meats.  Drink large amounts of fluids, especially water.  Drinking at least eight glasses of water a day is a must, especially when you're taking ARV medications.  Be wary of raw fish (sushi) or shellfish.  Sushi can harbor bacteria that may harm the liver and shellfish can contain the hepatitis A virus, which can cause serious liver problems in people who have not received the hepatitis A vaccine.  Also take care to avoid wild mushrooms.  Many types of wild mushrooms contain toxins that can cause serious damage to the liver.  Be cautious of an over use of supplements as they are metabolized by the liver and can put extra strain on it.  Do not use any supplements at this stage without first consulting your HIV Medical Specialist.  Foods such as liver and cooking equipment-such as iron skillets-high in iron should be used sparingly as well to begin with as excess iron, at this stage, can put a strain on the liver.

 Anemia

There are occasions when a HIV+ patient who has an already established ARV regimen may, under the guidance of their HIV Medical Specialist, increase the amount of Iron in their diet.  Sometimes, HIV+ people who have been on certain ARVs, particularly, Zidovudine (AZT, ZDV, Retrovir) may develop anemia. Anemia may be defined as a medical condition in which the red blood cell count, or hemoglobin, is less than normal.  Hemoglobin is the molecule that delivers oxygen to all parts of the body for consumption and carries carbon dioxide back to the lungs to be exhaled from the body.  If the hemoglobin level is low, this process may be impaired, resulting in low levels of oxygen in the body (hypoxia).  Iron is a major component of hemoglobin and is essential for its proper function.   Thus an increase in the amount of iron in the diet can help to combat, or prevent anemia. 
                                                 
IRON  RICH FOODS

The best sources of iron include iron fortified cereals, chicken and chicken liver, lean red meat, dried beans and legumes, clams, oysters, leafy greens, nuts and whole grains.  Iron obtained from animal sources is known as heme iron while iron obtained from plant sources is known as non heme iron.  Heme iron is better absorbed than non-heme iron in the body.

 Please note that Iron is only absorbed in the upper part of the small intestine during the first 4 hours of digestion and that   calcium inhibits its absorption and vice-verse so when having a meal of foods containing iron or, as the secondary resort, 

taking iron supplements, don't wash it down with a glass of milk.

IRON RICH FOODS - HEME IRON

Foods Milligrams of iron per serving
Chicken liver, cooked, 100g 12.8
Clams, mixed species, raw, 85g, 3 oz 11.8
Chicken, broiler or fryer, cooked, 1 cup, approx 145g 10.2
Oyster, breaded and fried, 3oz, 85g 5.9
Beef liver 3 oz, 85g 3.5 Beef, tenderloin, roasted, 3oz, 85g 3.0
Beef, eye of round, roasted, 3oz, 85g 2.2
Chicken, leg, meat only, roasted, 3.5oz, 100g 1.3
Chicken breast, roasted, 3 oz, 85g 1.1
Tuna, white, canned in water, 3 oz, 85g 0.8


IRON RICH FOODS - NON-HEME IRON

 Foods Milligrams of iron per serving
Ready-to-eat cereal, 100% iron fortified, ¾ cup 18.0
Oatmeal, instant, fortified, prepared with water, 1 cup 10.0
Soybeans, mature, boiled, 1 cup 8.8
Lentils, boiled, 1 cup 6.6
Beans, kidney, mature, boiled, 1 cup 5.2
Beans, pinto, mature, boiled, 1 cup 3.6
Spinach, boiled, drained, ½ cup 3.2
Black-eyed peas (cowpeas), boiled, 1 cup 1.8
Garbanzo beans, cooked, 1 cup, 164g 1.74
Beet greens, cooked, 1 cup, 144g 2.74
Peas, frozen, cooked, 1cup, 160g 2.43
Rice, white, long grained, cooked, 1 cup, 158g 1.9
Cashew nuts, 1oz (18 nuts) 1.72
Pine nuts, dried (chilgoza or neje) 1oz, 28.35g 1.6
Beets, cooked, 1 cup, 170g 1.34
Plantain, raw, 1 medium, 179g 1.07
Almonds, 1 oz (24nuts) 1.05

ABSORPTION OF IRON – IRON RICH FOODS

 Generally, about 10 to 15% of iron in the diet is absorbed by the body, though individual variations occur. The human body is calibrated to maintain iron levels/stores within normal limits. Thus, absorption increases in individuals who are iron deficient and decreases in normal individuals to prevent iron overload.

 Heme iron, found in meat, poultry and fish is much better absorbed by the body than non heme iron found in vegetables, legumes, grains and fruits. Consequently, vegetarians are at increased risk for developing iron deficiency. Eating heme - iron rich foods with vitamin C in a meal, enhances absorption of non heme iron consumed in the same meal. Vegetarians must be careful to include foods that contain vitamin C such as oranges, orange juice, lemon juice, cantaloupe, strawberries, broccoli, tomatoes and bell peppers in their meals to enhance absorption of iron.

 To absorb the most iron from the foods you eat, avoid drinking coffee or tea or consuming calcium-rich foods or drinks or egg yolk with meals containing iron-rich foods for at least 2, and ideally 4 hours after the meal.   Also, if you are on a high fiber diet, or eat a high fiber meal, ensure that you allow 4 hours either side before you eat your next meal high in Iron.

Liver Steak Recipe | Panlasang Pinoy

I hope you have found this answer useful.

Credits:
Cindy Moore, MS, RD, director of nutrition therapy at the Cleveland Clinic Foundation
Dr Mattana Hanvanich, HIV Medical Specialist, Bumrungrad International Hospital, Thailand

Stay healthy, and if you’re on ARV, compliant with your ARV regimen.

Malcolm Brown.