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“Can People with HIV Eat Sushi?”: Your HIV & Diet Questions Answered

, by Joanna Eveland, MD

Joanna Eveland, MD

Joanna Eveland, MD

Eating the right kinds of food and maintaining a balanced diet are key to maintaining overall health. For people with HIV, the association between nutrition and health is even more pronounced. Most of my patients have their HIV well controlled but have high blood pressure, high cholesterol or are at risk of developing diabetes—all conditions connected to nutrition. I tell my patients that planning and eating nutritious meals is just as important as remembering to take your HIV medicines every day.

Food is medicine, and eating the right kinds of foods can result in more energy, less stomach upset, stronger bones, a more robust immune system and a healthier heart. I’m always happy when—instead of prescribing more pills—we can fix a patient’s health problem with a change in diet.

In the early days of the AIDS epidemic, HIV providers used to worry about wasting and weight loss due to HIV. With the development of better HIV medicines, people are living longer and there’s less worry that they’ll develop opportunistic infections. Instead, the top health concerns for people with HIV are the same nutrition and diet-associated health problems faced by other Americans, like becoming overweight or obese. I often worry more about the impact of fast food and soda on my patients than I do about them getting sick from something related to HIV. My patients worry about the long-term effects of HIV and HIV medicines on their liver, kidney, or bones, but a poor diet can actually be the more pressing concern.

As much as we all want to eat healthily, it can be difficult. For most of us, food can be a source of comfort and a way to cope with emotional stress. When things get busy or tough, we often turn to the sugary, salty, high-fat foods that make us feel full and satisfied fast. For many of us, it’s hard to find time to shop for food and cook at home. For those on a fixed income, buying healthy food often competes with other priorities. And it also feels like nutrition guidelines are always changing. How do we even keep up?

To address these concerns, I asked registered dietitian Kristi Friesen from Project Open Hand to attend a San Francisco AIDS Foundation Positive Force event to answer questions that people with HIV have about diet and nutrition. Here’s what we learned.

Do people with HIV need to eat more protein?

Kristi Friesen: The short answer is no. Overall, in our population we’re seeing more and more damage being done from people eating a high protein diet. It’s hard for the kidneys to process too much protein. It’s important to have some protein at every meal—but there’s no need to buy protein powders or have more than a quarter of your plate be a high-protein food.

I’ve heard that people with HIV shouldn’t eat sushi. Is that true?

It’s true that people with compromised immune systems need to be more careful about food poisoning, since you may be more likely to get sick from eating uncooked or improperly cooked food. With raw fish, there’s a risk that, because the food hasn’t been heated, there’s bacterial contamination. I’d advise that if you want to eat sushi, be careful about where you’re eating it. Go to restaurants that you can trust store their food properly. Be wary about sushi boat places if you see the plates of sushi circulating for a long time.

I’ve heard that I should be eating 9 servings of fruits and vegetables a day. That seems like a lot! How is it realistically possible to eat the necessary amounts of fruits and veggies?

Keep in mind that a serving size is a lot smaller than what most people think. For broccoli, for example, a serving size is only ½ a cup. When I’m eating broccoli, I could easily eat 2 cups, which is 4 servings right there. A large banana would be 2 servings. A big salad might have 4 to 5 servings of vegetables in it. So it’s easier to eat 9 servings of fruits and veggies during the day than you might think.

Should I eat brown rice or white rice?

White rice and brown rice are the same grain, but brown rice hasn’t had its outside hull—the endosperm—removed so it has more nutrients in it and more fiber. White rice is softer and cooks more quickly. While there’s more nutrients in brown rice, for people with HIV that have stomach or GI discomfort, white rice may be the better option.

I can never remember if I should or shouldn’t be eating eggs according to the latest dietary recommendations. What’s the latest word on eggs?

Eggs contain saturated fat, which can raise your blood cholesterol. But we usually advise that people can eat one to two eggs per day. If you’re worried about your cholesterol, eating more fiber will help you lower it.

Eating organic food can be expensive. Is it worth it to only buy organic?

If you’re worried about the harm that may come from hormones and pesticides, you can reduce your risk by eating organic meat and dairy products. You’ll have the most impact by doing this first. Then, I recommend looking at the Environmental Working Group’s Guide to Pesticides in Produce. The Dirty Dozen are a list of 12 fruits and vegetables that absorb the most pesticides and that are worth buying organic if you can. The Clean Fifteen are 15 fruits and veggies that you may not need to buy organic since they don’t absorb a lot of pesticides or have an outer covering that you wouldn’t eat.

Do people with HIV need to drink any more or less water?

If you have vomiting or diarrhea, you’re going to lose fluids that you’ll need to replace. Medications might also affect your fluid needs. It’s difficult to say one recommendation for everyone, but the Institute of Medicine recommends, for men, 13 glasses of water per day. You can count other fluids, like juice, in this total in addition to foods, like fruits and veggies, that contain a lot of water.

Are there any foods I can eat that are anti-inflammatory?

Fruits, vegetables and whole grains are anti-inflammatory. As are onions, garlic, and ginger. It’s great to include these foods in your diet.

Should I take supplements?

A multivitamin, for most people, is helpful. But I usually don’t recommend individual supplements, like extra vitamin E or zinc. It can be easy to throw off your body’s natural balance and it can be easy to take too much if you’re doing it on your own without the advice of a doctor.

Keep in mind that the supplement industry isn’t regulated the way the pharmaceutical industry is regulated. There’s not much proven benefit to a lot of supplements, they can be expensive, and they may cause people to unnecessarily take too many pills. In my opinion, it’s better to spend your money on good, healthy food every week.

What should a person who is lactose intolerant be aware of?

People usually get calcium from dairy, so someone who is avoiding dairy will need to get calcium from other sources. People who have mild lactose intolerance can usually take an enzyme called lactase to help digest dairy. Some plant foods provide calcium, like tofu, bok choy and cabbage, but not as much as dairy foods do.

People with HIV can have lowered bone density. Are there foods I can eat to lessen the chances I’ll develop bone density problems?

Calcium, vitamin D, magnesium and vitamin K improve bone density. To get these nutrients eat dairy products, which are rich in calcium, dark leafy green vegetables, broccoli or bok choy, and fish like salmon, anchovies or sardines.

For more information about diet and nutrition, check out Project Open Hand’s blog with regular articles, recipes and nutrition tips from Kristi Friesen.  Read more about nutrition guidelines for people with HIV on AVERT.

Joanna Eveland, MD, is an HIV treatment specialist in San Francisco. She oversees HIV and homeless services as the Clinical Chief for Special Populations at the Mission Neighborhood Health Center, is a faculty member at the University of California, San Francisco Clinician Consultation Center, and leads a bi-monthly health education group for HIV-positive men through San Francisco AIDS Foundation. Dr. Eveland received her M.S. and M.D. at the University of California, Berkeley-UCSF Joint Medical Program and completed her residency at the Contra Costa Family Medicine Residency Program.

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