The Task Force on Nutrition Support in Aids has the following nutrition goals for people testing positive for the HIV-virus:

1. prevention of weight loss

2. normal growth in children

3. prevention of nutrient deficiencies, and

4. and adequate storage of nutrients

The task force believes nutrition counseling from diagnosis can help a person meet these goals. A nutrition counselor can:

1. tell if your diet is adequate

2. check for changes in weight or muscle mass

3. offer ideas for improving your diet

4. teach you about special food or vitamin-mineral supplements

5. help plan low cost meals and

6. instruct you or your caregiver on tube or intravenous feedings, if needed.

• At diagnosis
  
• If having food intolerance
  
• When appetite is poor
  
• When having nausea and vomiting
• When there is weight loss
  
• When wounds heal slowly
  
• When lab values show nutrient deficiencies
  
• When there are problems eating
  
• When advice is needed on unusual diets or vitamin-mineral supplements
  
• When there is constipation or diarrhea
  
• When going on or going off a tube feeding or intravenous feeding
  
• When oral liquid supplements are needed
  
• When there are other chronic diseases like diabetes or high blood pressure
  
• When aid is needed to finance nutrition support
  
• Whenever there are questions about food
  

If you cannot eat enough regular food, drink high calorie liquids. You may take these by mouth or by tube. Taste, health of your intestine and the number of calories needed will decide which one is best for you. Ask a registered dietitian or nutritionist for recipes to make liquid supplements taste better.

Talk to your doctor about vitamin-mineral supplements. He may recommend supplements of water-soluble vitamins like B12 and folate and minerals like zinc. Take these supplements carefully. Only lab tests can tell when the amount is right. Taking large doses may do more harm than good.

Do not be tempted to try non-traditional treatments for the HIV-virus. Fad diets such as the macrobiotic diet or various herb mixtures do not help and can be expensive.

When shopping, only buy the freshest food. Never choose food that is out-of-date. Buy only the amount you can use by the expiration date on the label. Use more single-serving foods like mayonnaise in individual packets.

Use pasteurized dairy products. Even cheese should be made from pasteurized milk.

Never buy eggs that are cracked or leaking. Store them in the original carton in the main section of the refrigerator instead of in the refrigerator door.

Eggs are usually safe if they are used within two weeks after the sell-date on the carton. Eggs can be washed right before they are cracked. Do not store eggs again once they are washed.

To prevent leaking on other food, put raw meat, fish and poultry in separate plastic bags before you put them in the grocery cart.

Plan your errands so you grocery shop last. Then you can go home right away and store your food.

When fixing food wash your hands well and sanitize the preparation area. Cover all open wounds to prevent infection. Disinfect appliances, sponges, dishrags and food preparation surfaces with a solution of 1 part bleach to 10 parts water. Do not use wooden cutting boards. Have separate plastic boards for raw and cooked foods. Use different utensils for serving and eating. Never drink or eat directly from food or drink packages. Wash all fresh fruits and vegetables, then peel. If you are ill, do not eat raw fruits and vegetables until you are well. Even food cooked in the microwave or stir-fried may not be cooked well enough when you are sick. Canned food may be safest. Bring canned food to a boil before eating.

When microwaving, follow directions for cooking times and stand times. Turn or stir the food during cooking to be sure it is evenly heated.

Do not cook any raw, high protein food like eggs or meat in the microwave. The temperature and cooking time may be not enough to prevent food poisoning. A microwave oven, however, is good for heating leftovers quickly.

Never thaw food at room temperature. Thaw in the refrigerator or microwave.

Only eat well-done meat, fish and poultry. A meat thermometer is the best way to be sure your food is thoroughly cooked. If you are grilling, pre-cook meat and poultry to be sure they are well done.

Nothing made with raw or undercooked eggs is safe. Make eggnog, hollandaise sauce, ice cream and Caesar salad dressing with pasteurized eggs, such as Egg Beaters , or well-cooked eggs only.

Store food in shallow, small, covered containers. Do not eat any food stored more than two days or that looks or smells strange. Throw away food left out at room temperature for more than two hours. Reheat leftovers completely.

Test well or spring water before drinking. Boil this water to be sure it is safe.

People with HIV often have eating problems. These include poor appetite (anorexia), weight loss, swallowing problems, heartburn, diarrhea, poor absorption, sores in the mouth or throat, and increased calorie and nutrient needs.

Anorexia, weight loss and taste changes can be due to the HIV-virus, its treatment and/or depression and anxiety. Children especially may become more fussy about their food. Here are some ideas that may help:

1. If meat tastes metallic or bitter, switch to poultry, fish, eggs, dairy products, dried beans and peas or peanut butter for protein.

2. Eat food cold or at room temperature.

3. Marinate meat, fish or poultry in juice, wine, salad dressing, or sweet and sour sauce in the refrigerator.

4. Increase seasonings.

1. Eat small, frequent, calorie-dense meals.

2. Eat on attractive dishes with good silverware in a pleasant setting.

3. Eat with others.

4. Keep liquids with calories on ice nearby to sip on throughout the day.

5. If medicine dulls the appetite, ask to take it after meals.

6. If tube feedings are needed, stop them 60 to 90 minutes before a meal.

7. Eat more high carbohydrate foods like jelly, fruit, rice and noodles since they are digested faster.

1. Record weight weekly since daily changes are normal.

2. Use whole fat dairy products.

3. Add dried fruits to cereals, salads, breads, entrees and desserts.

4. Eat fruits, puddings and ice cream for dessert.

5. Top or season foods with sauces, gravies, margarines, butter, cheese, salad dressing and mayonnaise.

6. Add 1/3 cup dry milk to 1 cup fluid milk to make "Double Milk." Use in recipes or over cereal.

7. Substitute evaporated milk for regular milk in recipes.

8. Add Polycose, a high carbohydrate powder, to liquids and solids like juice and mashed potatoes to add calories.

9. Add non-fat dry milk to recipes for meat patties, meat loaves, breads, cream soups, puddings, milk shakes, egg dishes, casseroles or cooked cereals.

The HIV-virus and its treatment can cause problems with eating and digesting food. These problems include sore mouth and throat, swallowing problems, nausea, vomiting and diarrhea. Here are some ways to control these problems:

1. Eat cold or room-temperature food and liquids.

2. Avoid acidic foods like citrus fruits or tomatoes.

3. Eat soft, bland foods like ice cream, pudding, cream soup, mild cheese, eggs, yogurt, cooked or pureed fruit, or mild pasta or potato dishes.

4. Moisten food with sauces or gravies.

5. Drink a sip of beverage before each bite or dip the food in liquid before eating.

6. Chew gum or eat hard candy to increase saliva in the mouth. Artificial saliva is also available to help dry mouth.

7. Keep your teeth and gums clean. Change your tooth brush every 6-8 weeks and/or soak it in disinfectant mouthwash overnight and rinse well.

8. Suck on a juice bar or popsicle before a meal or ask for medicine to numb your mouth.

1. Thicken liquids with a product like Thick-it or with non-fat dry milk, rice baby cereal, instant mashed potatoes, blenderized graham crackers or cornstarch.

2. Foods with one consistency are usually easier to swallow. Blenderize or puree food if needed.

3. Avoid sticky food like peanut butter or slippery food like jello or lunch meat.

4. Do not eat popcorn. It can irritate the mouth or throat and may cause choking.

5. During meals, sit upright with foot support. Slumping makes swallowing harder.

6. Stroke the throat downward while swallowing.

7. For more help, ask to see a speech therapist.

1. When most ill, lower the fat and sugar in the diet. Eat higher fat food when you feel better.

2. Eat salty, dry foods like crackers and dry cereal before getting out of bed.

3. Between meals, drink fluids slowly with a straw.

4. Eat food cold to reduce odors.

5. Eat smaller, more frequent meals.

6. Keep the room well-aired.

7. Sit up for a while after eating.

1. Eat a clear liquid diet for a short time. Include clear soups like chicken or beef broth, uncarbonated drinks, jello, popsicles, and diluted juices. Drink plenty of fluids to replace fluid losses.

2. Avoid regular milk. Try whole milk treated with Lactaid or Dairyease drops, aged cheese or yogurt if your diarrhea is not too severe. You can also drink and cook with soy milk or soy infant formula.

3. Eat a low fat diet for a while if you are not absorbing fat well.

4. Eat applesauce, grated, peeled apples or pears, oatmeal or oatbran, or potatoes. Apple flakes can also be added to cooked cereal. All of these contain soluble fiber that will act as a bulking agent.

5. Avoid nuts, seeds, raw wheat bran or foods made with whole wheat.

6. Drink caffeine-free beverages and foods made without chocolate. Caffeine acts as a stimulant.

7. Do not eat gas-producing foods like cabbage, dried beans and peas, cauliflower, broccoli, highly seasoned foods, large amounts of sweets and sugar-free food made with sorbitol.

8. Eat high potassium foods like potatoes and bananas.

9. Try metamucil or high fiber bran cereals to firm up watery stools.

10. Ask your doctor to prescribe a medicine to control diarrhea.

If none of these ideas work, you may need a special "elemental" diet either by mouth or by tube. Only your doctor and dietitian can instruct you on this.

Always ask for written directions about how to change or improve your diet. This will help you remember what you should do. This will also help anyone else who fixes food for you.

Ask where you can get help with food preparation. Some volunteer organizations will buy food or deliver meals to your home. Also accept help from friends who offer to fix meals for you. You may also want to use take-out food from delis and restaurants but be sure this food is kept at the right temperature before you eat it.

Nutrition and good food sanitation are two things to help your mental and physical well- being. You can take charge of your health by eating the best food possible prepared in the safest way possible.

1. Beach, R. "Malnutrition in Patients in HIV Infection and Aids." Nutrition and the MD, Vol 15, No. 8, August, 1989.

2. Eating Defensively: Food Safety Advice for Persons with Aids, Video, Centers for Disease Control.

3. "Food Safety for People with HIV/AIDS." Food Protection Inside Reports, January, 1992.

4. "Food Handling for High Risk Populations." The Grapevine, February 1991.

5. Hopkins, B. and Hunt, N. Nutrition Update: Nutrition and AIDS. Georgia Department of Human Resources. (No date).

6. McLoughlin, L. "Nutrition and gastrointestinal disease in acquired immunodeficiency syndrome." Topics in Clinical Nutrition. Vol. 3 No. 4, 1988.

7. McQuiggan, M.M. and Andrassy, R.J. "Nutrition Support of the AIDS Patient," RD,Vol. 10, No. 3, September, 1991.

8. Schreiner, J. Nutrition Handbook for AIDS. Carrot Top Nutrition Resources, 2nd Edition, Revised 1992.

9. Taber-Pike, J. et al. Nutrition and AIDS: Guidelines for PWA's/PWARCS. ARIS Project, 1987.

10. Task Force on Nutrition Support in AIDS. "Guidelines for Nutrition Support in AIDS." Nutrition Today July/August, 1989.

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