Alaine Mills, Dietetic Intern HIV & Nutrition Alaine Mills, Dietetic Intern

Outline Why is it important to have a healthy diet? What is a healthy diet? Possible co-morbidities Managing side effects Food Safety Questions

Why is it important to have a healthy diet? Maintaining/Restoring Body Weight Managing Side Effects Eating Enough Exercise Marinating body weight helps keeps us strong, healthy, and able to fight off infection. energy

Why do I have increased energy needs? Fever Infections

What is a healthy diet? Balanced; whole grains, protein, fruits and veg and dairy products; variety

What foods should I focus on? Protein Fruits & Vegetables Protein for building and maintaining body mass Fruits and vegetables

Why Protein? Helps maintain and build body mass, including muscles, and a strong immune system

What foods are high in protein?

Why fruits & vegetables? Antioxidants

Immune Supporting Nutrients Omega-3 Salmon, almonds, walnuts Vitamin C Citrus fruits Vitamin A Carrots, sweet potatoes Vitamin E Spinach, sunflower seeds, almonds Zinc Protein, legumes, oatmeal

Possible Co-Morbidities with Nutritional Implications Hyperglycemia Kidney & liver disease Hypertension Hypothyroidism Hyperlipidemia Osteopenia Changes in body composition Malnutrition Pancreatitis Wasting

Hyperglycemia What is it? High blood sugar Symptoms: excessive thirst & hunger, frequent urination, weight loss Why does it matter? Can lead to vascular diseases affecting the eyes, heart, kidney, nerves, and limbs

Nutritional Management of Hyperglycemia Avoid concentrated sweets (candy, soda, baked goods, etc) Whole Grains Protein with all meals and snacks

Hypertension What is it? What does it matter? Persistent high blood pressure What does it matter? It is associated with increased incidence of heart & kidney disease

Nutritional Management of Hypertension Increase fruits, vegetables, and low fat dairy Reduce sodium intake Moderation of alcohol consumption

Hyperlipidemia What is it? Cannot be identified without a lab test Abnormal amounts of lipids in the blood Cholesterol & triglycerides Cannot be identified without a lab test Can result from some drugs What does it matter? Can lead to serious health problems, such as heart disease Cholesterol can build up in the arteries and form plaque Pancreatitis Painful inflammation of the pancreas Total cholesterol – less than 200 Low-density lipoproteins (LDL) – less than 100 High-density lipoproteins (HDL) – 60 or higher Triglycerides – less than 150

Nutritional management of hyperlipidemia Reduced intake of saturated fats Red meats, butter, baked and fried foods Increase intake of mono- and poly- unsaturated fats Fish & seafood, nuts & seeds, soy, vegetable and canola oil Increase fiber intake Whole grains, veggies Limit alcohol <2 glasses per day Exercise!

Osteopenia What is it? What causes it? Low bone mineral density Inadequate calcium and vitamin D intake or status Low body weight Certain medications Lack of physical activity

Nutrition for Osteopenia Adequate Calcium (Milk, cheese, yogurt, pudding, dark green veggies) Adequate vitamin D intake (fish, milk, supplements, and from the sun) Balanced diet

Nutrition Related Complications Nausea Mouth or throat sores Dry mouth Loss of taste Fatigue Diarrhea Constipation Not eating enough Weight loss

Nausea Cause: Why is it important? Management: Medications May cause you to not eat as much as you should Management: Small, frequent meals Avoid high-fat, greasy foods Cool or room temperature foods Avoid lying down after eating Take medications after the meal or with food

Mouth or Throat Sores Causes: Why is it important? Management: Bacteria, virus, or fungus Why is it important? May cause you to not eat as much as you should Management: Soft, moist food Avoid spicy or acidic foods Cool or room-temperature foods Nutrient and energy dense foods Medicated mouthwash

Dry Mouth (Xerostomia) Cause: Medications Why is it important? May cause you to not eat as much as you should Management: Moist foods Drink lots of fluids Good oral hygiene Use artificial saliva Sour or tart foods Chew gum Suck on hard candy or ice Avoid alcohol (check your mouthwash)

Loss of Taste (Dysguesia) Causes Why is it important? Management: Avoid red meat Avoid metal utensils Use marinades/seasonings

Fatigue Causes: Why is it important? Management: Medications, anemia May cause you to not eat as much as you should Management: Get enough sleep Exercise Make sure you are eating enough Avoid alcohol & tobacco Seek treatment for anxiety or depression Avoid stress Ready to eat foods or foods that require little preparation

Diarrhea Causes: Why is it important? Management: Numerous- medications, bacteria, fungi, disease, diet Why is it important? May cause malabsorption of nutrients and dehydration Management: Drink plenty of fluids (water) Electrolytes (salt, bananas, potatoes, sports drinks) Limit dairy Avoid gas causing foods and beverages Avoid greasy and spicy foods Take medications after meals Soluble fiber (white bread, bananas) Anti-diarrheal medication

Constipation Causes: Why is it important? Management: Medications, diet Why is it important? May cause you to not eat as much as you should Management: Drink more fluids Eat more fiber (whole grains, fruits, vegetables, legumes)

Not Eating Enough (Inadequate Food Consumption) Causes: Medications, increased energy needs Why is it important? Good nutrition improves the quality of life and may prolong it Management: Nutrient and energy dense foods Small, frequent, meals and snacks Nutrition supplements Appetite stimulants

Weight Loss Causes: Why it matters? Management: Not eating enough, increased energy needs, medications, hormone imbalances Why it matters? Management: Eat more (especially protein) Manage eating associated ‘ symptoms Resistance exercise Steroids

Food Safety Wash your hands with soap and warm water before you eat or prepare food Wash all fruits and vegetables with soap and warm water Make sure your refrigerator is less then 41 degrees F Keep cold foods cold and hot foods hot Only keep leftovers for 24 hours Cook meats well done Avoid: sushi, raw eggs, raw oysters, buffets

Questions?