THERAPY OF THE MONTH
NUTRITIONAL THERAPY
We’ve all heard the adage ‘You are what you eat’. But is it true? And what does that mean for people living with HIV? Nutritional therapist Steve Davis explains
Food has been an important part of healthcare for as long as people have been
eating. And the value of a varied, micronutrient-rich diet is well recognised.
But the focus has mainly been on eliminating deficiency diseases from an average
population.
Nutritional therapy aims to modify the body’s responses to its health
condition in a way that improves the quality of life beyond the elimination
of deficiency conditions.
The principles can easily be applied to our lives:
• Remove foods, including supplements, causing problems
• Replace with alternatives
• Make dietary changes to improve general health and help deal with
particular problems
• Design supplement protocols tailored to the needs of the individual.
Without a good, well-absorbed diet, supplementation has limited effectiveness.
General advice for those with HIV is the same as for the whole population,
eat regularly, have a wide range of fruit and vegetables, plus good quality
protein sources - either animal or vegetable. Keep animal and cooked fats
to a minimum and avoid simple carbohydrates and sugar. Drink plenty of water
and avoid caffeine. Not very exciting so far, but this is untailored advice
to a general population.
A nutritional therapist will assess the patient’s diet and lifestyle,
plus their specific health problems and then tailor diet and supplementation
to the individual. Even if two patients present with the same condition, the
treatment offered will be subtly different.
Digestion
Long-term survivors often have slight mal-absorption from the action of HIV
on the gut lining. People suffering from chronic, low-level diarrhoea also
suffer from malabsorption and mal-digestion due to the brief time food is
in the gut. Getting the digestion right can improve energy levels and reduce
wasting, with the bonus of usually reducing the discomfort.
Antibiotics, under medical supervision, can be used to eliminate diarrhoea-causing
pathogens. By increasing protein, reducing carbohydrate and balancing fat
intake, lean muscle can be rebuilt; excessive “empty” calories
are limited and body fat can be reduced to healthy levels.
Supplementation and dietary tricks
These may help improve digestion and absorption. Pineapple or lemon juice
in water, taken just before eating, can stimulate appetite and production
of digestive juices in the stomach, which will then stimulate later stages
of digestion. Bromelain supplements or pineapple juice can also be used to
assist in the digestion of proteins, though too much of any of these may cause
stomach upset.
B Complex vitamins are cofactors for protein production, including muscle
protein and digestive enzymes. In long-term mal-absorption, B vitamins may
drop to levels that limit the production of proteins. This leads to poor digestion,
reduced food absorption and further limits protein production due to a lack
of dietary amino acids. While B vitamin supplementation may be necessary,
those taking HAART should take the supplement cautiously. HAART medications
put stress on the liver, and B vitamin supplementation can add to this, causing
nausea and fatigue, especially if taken at the same time as medications.
Food sensitivities
Many patients with HIV have mild food sensitivities that can usually be identified
quickly and dealt with using either elimination or rotation diets. Such sensitivities
are often tolerable, but may set up inflammatory processes that, in unsuppressed
HIV, can trigger viral replication. Removal of the food sensitivity and treatment
with a balance of omega 3 and omega 6 oils can calm these inflammatory processes.
Lipo
A side effect of HAART is lipodystrophy, or fat redistribution. Limiting fat
intake during a meal, and ensuring that there is a large proportion of omega
3 and omega 6 oils, may help reduce fat redistribution. Long-term dietary
changes to reduce total body fat will reduce the fat that’s available
for redistribution.
Interactions
Some foods and supplements affect HAART. Garlic, Echinacea, and especially
St John’s Wort may reduce the effectiveness of certain HAART drugs while
grapefruit juice can increase certain drug levels.
The fat content in foods can also change the way drugs are absorbed. Zinc
supplementation above 15mg per day has been linked to increased viral replication,
and a strongly detoxifying diet may lower HAART drug levels too fast. All
these aspects of diet, plus many others, must be carefully checked to get
the greatest benefit from both conventional and nutritional therapy.
For many of us, taking personal control of part of our treatment is central
to our health, both physical and mental. With food part of daily life, individually
tailored nutritional therapy is an effective way of maintaining good health,
supporting HAART, and helping to manage medication side effects.
• steve.davis9@btinternet.com
• When dealing with HIV or other serious health conditions, nutritional
therapy should be considered as supportive therapy, complimentary to conventional
therapies.
