foodfor life

Meals with Love for People

with AIDS

A G U I D E T O P O S I T I V E N U T R I T I O NA G U I D E T O P O S I T I V E N U T R I T I O N

Special support for this booklet was

provided by Levis Strauss & Co.

Project Open Hand provides meals,

groceries and nutrition counseling

to thousands of people living with

symptomatic HIV and AIDS in San

Francisco and Alameda counties.

Acknowledgments

Project Open Hand and the steaming pot logo are registered trademarks of Project Open Hand, a California Corporation.

PrinterPress Works

What’s Inside1 Eating Well Can Make a Difference 3 2 The Basics of Eating Well 4 3 Keeping Food and Drinks Safe 6 4 Keeping a Weight That’s Right for You 11 5 Getting the Exercise You Need 126 What is Body Composition? 15 7 Coping with Symptoms: Diarrhea, Nausea & Mouth Problems 168 Nutrition and Women with HIV 219 Balancing Medications and Meals 2310 What About Vitamins? 2511 Eating Well Without a Kitchen 2612 Eating Well if You’re Using or in Recovery 28

WriterLisa Awrey

Project Open Hand Staff Dietitians

DesignerCavecche Graphics

PhotographersKatherine DuTielTom Levy

It’s never

too late to start

eating well.

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P O S I T I V E N U T R I T I O N11

Did you know that something as simple as eating well can change the course of HIV disease for the bet-

ter? The food you eat can make a differ-ence in how your body fights infection, how it reacts to medications and therapies, and how you feel. Eating well is simple but not always easy for someone with the special needs of living with HIV and AIDS. This is a time to take care of yourself. One of the first and best ways you can fight infections is through the food you eat. This booklet will help you learn more about some basic things you can do to feel better and live longer. Use the information to ask your doctor and dieti-

tian about your symptoms and the food that’s best for you. It’s never too late to start eating well. The more you know now about good nutrition, exercise, vitamins, and com-bined medications, the sooner you can positively affect your health and your life. There is hope, and you are not alone. Please share this information with family and friends who can help you or who may need it for themselves. From all of us at Project Open Hand, we wish you hope, love, and good health.

Eating Well Can Make a Difference

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Eating well is simple but not always easy.

The Basics of Eating Well

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P O S I T I V E N U T R I T I O N22

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If you can’t drink milk, try eating broccoli, bok choy, sardines with bones, tofu, soy milk or orange juice that’s fortified with calcium.

E ating well is important when you have HIV. Whether you already have symptoms or

have just been diagnosed, it’s never too early to start eating well. Eating healthy food and keeping a healthy weight helps your immune system and body fight infections. Whether you cook at home or eat out, choose food that tastes good and is good for you.

Here are some basic things you can do to feel better and stay healthier longer.

■ Eat enough food to keep at a weight that’s right for you.

■ Eat more food with protein to build muscles and repair damaged tissues.

■ Drink plenty of water and other liquids. Replace any fluids you’ve lost.

■ Keep food and drinks safe from harmful germs that can make you sick. Be careful when you shop for, fix, and store food.

■ Get the exercise you need.

■ Eat enough food each day to give you the energy, vitamins, minerals, and other things you need to keep your body strong.

Eat dairy food or

calcium alternates

2-3 times a day

Try to eat a wide variety

of foods with plenty of

fruits, vegetables, breads,

and cereals each day.

Eat meat, poultry, fish, dry

beans, eggs, nuts and other

food with protein

2-3 times a day

Eat less fats,

oils, and sweets

Eat fruit 2-4

times a day

Eat vegetables at

least 3 times a day

Eat bread, cereal, rice or pasta

at every meal or snack

Food GuidePyramid

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F ood that’s safe to eat is really important for people living with HIV. With a weaker immune

system, you are more likely to get sick from harmful germs in food and water. You can prevent this by making sure the food you eat is safe.

Be careful when you shop for food:

■ Make grocery shopping your last errand of the day so you can get food home and stored as soon as you can.

■ Open egg cartons and check for cracked or broken shells.

■ Make sure dairy products and juices are pasteurized.

■ Don’t buy fruits or vegetables that are soft, bruised or moldy.

■ Don’t buy food that looks spoiled or smells bad.

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P O S I T I V E N U T R I T I O N33Keeping Food and Drinks Safe

Check the dates stamped on food labels. Make sure foods are safe to eat.

Remember, it’s best to play it safe. When in doubt, throw it out!

Keeping Food and Drinks SafeKeep water safe:

■ Don’t drink tap water unless you boil it first—at a full, rolling boil for one minute. (Tap water may have germs that can cause severe diarrhea.)

■ Don’t use ice cubes made from water that’s not safe.

■ Use safe drinking water to makepowdered drinks and juice from concentrate.

■ Don’t swallow water while brushing your teeth or showering.

■ Drink bottled, distilled, or filtered water.

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Keep everything clean:

■ Wash fruits and vegetables, especially organic produce, well.

■ Wash hands, counters, utensils, and cutting boards with warm, soapy water—before and after they touch any food.

■ Clean utensils, sponges, counter tops, and cutting boards with bleach. Use 1 part bleach to 10 parts water. Rinse items with water.

■ Wash the lids of canned goods before you open them, and clean your can opener often.

Don’t taste foods you think might be bad. Often, you can’t see, smell, or taste the most harmful germs in food.

If you think you might be

sick from food you ate or water you

drank, call your doctor right away.

When you’re at home, be careful about storing and fixing food:

Keep hot foods hot

■ Cook foods, especially meats, until they’re well done. When done, red meat looks brown, poultry juices run clear, fish flakes when raked with a fork, and eggs are firm, not runny.

■ Reheat leftovers well or until bubbly hot.

Keep cold foods cold

■ Keep your refrigerator cool—below 400 F.

■ Make sure your freezer temperature is set at 00 F.

■ Refrigerate or freeze leftovers right away. Eat leftovers within two days.

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When you eat out:

■ Order meat and other foods well-done. Don’t eat meat with any redness in it.

■ Stay away from places that don’t look clean.

■ Eat only hot food that’s kept hot and cold food that’s kept cold. Avoid warming trays.

■ Don’t eat from salad bars. Don’t eat sushi or raw fish. (Cooked sushi like California rolls are okay.)

■ Don’t eat ice cubes; the water may not be safe.

Snacks are good for you:

■ Eat sandwiches, pizza, canned spaghetti, tacos, crackers and cheese, hard-boiled eggs, carrots, and apples.

■ Keep foods that are easy to fix like macaroni and cheese, tuna fish, chili beans, and soups on hand.

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Thaw frozen meats, poultry, fish, and eggs in the refrigerator or microwave. Don’t thaw foods on the counter at room temperature.

See page 26 if you don’t have a refrigerator or freezer.

HOW LONG WILL FOODS KEEP? Food Refrigerator Freezer

raw chicken or poultry 2-3 days 9 months raw meat 2-3 days 6-9 months raw hamburger, fish 1-2 days 3-6 months cooked meat 3-4 days eggs in shell 4-5 weeks don’t freeze milk 5 days past date on carton 1 month cheese 2-4 weeks 9 months butter 1-2 weeks 4-6 months

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4P O S I T I V E N U T R I T I O N4

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K eeping your weight stable is important, but sometimes hard for people with HIV. Things like

opportunistic infections, side effects from medication, and symptoms from HIV itself can make you lose weight. There are a lot of things you can do to keep the best weight for your body. Some people with HIV may need to eat less to maintain their best weight, but most people with HIV will find it necessary to gain weight.

Keeping a Weight That’s Right for You

Getting regular exercise builds healthy muscles.

If you need to gain weight, you might want to try to:

■ Eat a lot of snacks between meals. Three meals a day may not be enough.

■ Make fluids count. Drink shakes, nutritional supplements, punch, or fruit juices instead of water, tea, coffee, and diet soda.

■ Take advantage of the times you feel good and make large amounts of food that you can freeze into smaller portions. Defrost and heat a frozen meal when you don’t feel like cooking.

■ Cook and eat with friends, if you can. It’s more fun.

If you don’t feel like eating, check with your doctor about medicines that may help your appetite.

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Getting the Exercise You Need

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P O S I T I V E N U T R I T I O N55

G etting regular exercise can give you more energy, build stronger muscles, help you sleep better and feel good about yourself.

Exercise also helps you deal with stress. You should exercise at least 30 minutes most days. It doesn’t have to be strenuous, and you don’t have to do it all at once. A ten minute walk in the morning, a short stint of gardening in the afternoon, a bike ride to the store, and before you know it, you’ve done a half hour of exercise.

Make exercise part of your day. Start slow, be realistic, and don’t overdo it.

Cleaning house, sweeping, scrubbing, and reaching can be great workouts.

Remember to drink plenty of fluids when you do any kind of exercise.

Will taking steroids help me build strong muscles? Losing muscle mass is a common problem. Research shows some steroids help people with HIV build muscle, especially if

they exercise, too. Testosterone, oxandralone, and human growth hormone help some people’s appetites and may help put on muscle weight. But steroids can have harmful side effects, so talk to your doctor before you take any medication.

What about Steroids?

Keep it simple:

■ Take the stairs.

■ Walk to the store. Walk your dog.

■ Go out dancing or dance to your favorite music at home.

■ Walk the mall or commercial district. Go window shopping before the stores open.

■ Rent or buy an exercise video. Make sure it’s a safe workout that’s right for you.

Listen to your body

and rest when you

need to.

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P O S I T I V E N U T R I T I O N66

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B ody composition refers to your body make up: muscle, fat, water, and bone. Finding out what percentage

of your body is made up of muscle, fat, and water can help you make healthy changes. For example, you may need to get more exercise, improve your diet, or make choices about medicines.

There are some easy ways to measure body fat and muscle mass. You can get these tests at your medical center/clinic, gym, or by seeing a dietitian.

What Is Body Composition?

Things to remember:

■ Get advice about how to eat better and how to keep or reach a weight that feels right for you.

■ Ask your doctor or case manager where to find a dietitian.

■ Some common tests for body composition include bioelectrical impedance analysis (BIA) and skin-fold calipers. Be sure to check your body composition every 3 to 6 months for changes.

Project Open Hand offers free nutrition counseling to all its clients.

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P O S I T I V E N U T R I T I O N77

W hen you have HIV, sometimes

the food you eat can give you symptoms.

Often, certain foods can help ease your symptoms.

There may be times when you don’t feel like eating or when it’s just too hard to eat. There are a lot of things you can do so you don’t lose weight while you’re not feeling well.

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If diarrhea lasts for more than a day or if you have cramps, fever, or nausea, call your doctor.

If you have diabetes, high blood pressure, kidney disease, or other medical conditions, ask your doctor or dietitian for special advice.

Coping with Symptoms

Diarrhea Diarrhea is very common with HIV/AIDS. It can be caused by problems with digesting certain foods, medications, opportunistic infections, or food poisoning. It’s unpleasant and can make you lose weight.

If you have diarrhea, try to:

■ Eat white breads, white rice, bananas, applesauce, or plain pasta.

■ Drink as much water and other liquids as you can. You can lose a lot of fluids with diarrhea.

■ Eat oatmeal, oat bran, and breads with oats; they can help reduce the diarrhea.

■ Peel your fruit before you eat it.

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MENU FOR DIARRHEA

BREAKFASTcream of wheat or rice with brown sugarplain bagel with jellydecaffeinated coffee or herb tea2 glasses of boiled, filtered, or bottled water

SNAcK1 can nutritional supplementbananatoast with jelly2 glasses of boiled, filtered, or bottled water

LUNcHskinless breast of chickenwhite ricecooked carrots and green beans2 slices of white breaddiluted fruit juice—1/2 juice to 1/2 boiled, filtered, or bottled water

SNAcKhard boiled eggapplesaucetoast with jelly2 glasses of boiled, filtered, or bottled water

DINNERbroiled beef roundbaked potato with plain yogurt & low fat cheesesteamed winter squashdinner roll2 glasses of boiled, filtered, or bottled water

SNAcKpretzelsrice cereal with non-dairy milk substitute1 glass of boiled, filtered, or bottled water

Stay away from:

■ Food with a lot of fiber like raw vegetables, corn, brown rice andall nuts.

■ Milk and milk products like cheese, and ice cream.

■ Avoid caffeine, fried or greasy food, butter, oils, and food that’s spicy.

NauseaIf you feel sick to your stomach:

■ Drink a glass of boiled, filtered, or bottled water every half hour or so.

■ Suck on ice cubes or ice chips made from boiled or filtered water, if you don’t feel well enough to drink.

■ Drink cool clear drinks like ginger ale, lemon-lime soda, and fruit juice.

■ Eat plain, soft foods like rice, pudding, mashed potatoes, eggs, or unbuttered toast.

■ Eat small amounts of food often.

■ If you don’t feel better soon, ask your doctor for an anti-nausea medication.

Stay away from:

■ Food that is greasy or fried.

■ Spicy or sweet foods, caffeine, and alcohol.

■ Food with strong smells.

MENU FOR NAUSEA*

BREAKFASTbowl of plain grits, add low-fat cheeseplain bagel with jellydecaffeinated coffee or herb tea

SNAcKsaltine crackersmild cheddar cheesebanana1 glass of boiled, filtered, or bottled water

LUNcHchicken noodle soup with white ricesteamed carrotsdry toastl glass of boiled, filtered, or bottled water

SNAcKcold fruit saladplain yogurtcrackers1 glass of boiled, filtered, or bottled water

DINNERbaked, skinless chickenmashed potatoessteamed green beansdiluted fruit juice—1/2 juice to 1/2 boiled, filtered, or bottled water

SNAcKpretzelstapioca pudding1 glass of boiled, filtered, or bottled water

*Drink liquids between meals, so you don’t get too full.

If you feel sick to your stomach

eat saltine crakers or pretzels.

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Mouth Problems

S ometimes swallowing food can be hard. You may have sores in your mouth or an infection, and it may hurt to swallow.

Call your doctor if you have infections or trouble swallowing for more than a day.

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If you’re having problems with your mouth try:

■ Drinking through a straw.

■ Eating soft food like mashed potatoes, scrambled eggs, pudding, yogurt, and pasta.

■ Eating food that’s cold or at room temperature.

Stay away from:

■ Dry, sticky or crunchy foods like nuts, chips, crackers, rice, or peanut butter.

■ Citrus fruit and juice like orange, grapefruit, or tomato if you have sores in your mouth.

MENU FOR MOUTH PROBLEMS

BREAKFASTblended drink: fruit, nonfat or low-fat yogurt, milk or milk substitute, and ice made from boiled waterhot cereal2 glasses of boiled, filtered, or bottled water

SNAcKhummus (garbanzo bean spread) on soft breadrice puddingfruit juice mixed with boiled, filtered, or bottled water

LUNcHcream of chicken soupboiled, mashed peassoft bread, try soup broth to soften2 glasses of boiled, filtered, or bottled water

SNAcKblended drink: banana, apple juice, plain yogurt, and ice

DINNERchopped (or pureed), baked, skinless chicken breastrice (well-cooked)creamed corn with well-cooked green beansfruit juice mixed with boiled, filtered, or bottled water

SNAcKpuddingbanana1 glass boiled, filtered or bottled water

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Get regular exercise. It helps build muscle and gives you more energy.

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Eating well is a simple and important way you can start taking care of yourself.

Put Yourself First

M ore and more women have HIV today. If you are a woman with HIV, you have special needs.

Women’s bodies are different; they go through changes and have stresses that men do not. Many women are taught to take care of others before they take care of themselves. This is a time to think about yourself.

Nutrition and Women with HIV

Some basics:

■ Eat a variety of foods with plenty of fruits, vegetables, breads and cereals every day. (See the food guide on pg. 5)

■ Eat small meals or snacks throughout the day. Your schedule may be busy, especially if you have kids. So, you need to eat when you can.

■ Drink eight or more glasses of fluid every day. Stay away from drinks that dehydrate you like alcohol, coffee, or tea.

■ Take a multi-vitamin/mineral supplement every day. But know that a vitamin or mineral supplement doesn’t replace healthy eating.

■ Keep at a weight that’s usual for you, unless you are over weight.

■ Talk to your doctor or dietitian before making any drastic changes that would bring your weight up or down.

■ Take time for yourself, and get as much rest as you can.

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Pregnancy is a time to eat well. If you are pregnant and have HIV, you need to eat enough food to keep your body strong and your growing baby healthy. Pregnant women need to gain 25-35 lbs. to help the baby grow to a healthy weight. Talk to your doctor or dietitian about choosing the best food for you. Stay away from cigarettes, alcohol, caffeine and other substances that can be harmful to the baby. Take only medications that your doctor has given you while you are pregnant.

*Check with your doctor first before breast feeding.

It is recommended that women with HIV do not breast

feed their babies. You should talk to a doctor about

breast feeding options.

MENU FOR PREGNANcY

BREAKFASTbowl of cereal with nonfat milk or milk substitute sliced bananawhole wheat toast with jam or jellyorange juice

SNAcKhard-cooked eggcrackers with cheddar cheeseapple2 glasses boiled, filtered, or bottled water

LUNcHhamburger on a bun with lettuce,tomato, and cheesegarden salad with ‘lite’ vinaigrette dressingchocolate shake

SNAcKlow fat cottage cheesewhole wheat rollcarrot sticks2 glasses boiled, filtered, or bottled water

DINNERbaked or broiled, skinless chicken breastrice with margarinegreensmelon chunksmineral water with lemon

SNAcKgraham crackersyogurtnonfat milk

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To help make the medicine you take work for you:

■ See your doctor regularly. Be sure to take your medication as directed.

■ Ask your doctor or pharmacist if there are any special directions for the medicine you are taking. For example, should it be taken with food or on an empty stomach?

■ Work closely with your doctor, nurse, or dietitian to find the right balance between the foods you eat and the medicine you take.

■ Don’t start or stop taking any medication on your own. Talk to your doctor or nurse first.

■ Drink plenty of fluids with your medicine and throughout the day.

Balancing Medications and Meals

Set and keep a regular schedule for taking your medicines and meals. Try to eat at the same time every day.

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N ew treatments and combination therapies are good news for some people living with HIV.

But taking any medication can be confusing. Special directions can be hard to follow, and medicines can have many side effects, especially in the first few months you take them. The foods you eat might help lessen side effects.

Whatever therapies or

medications you take,

it’s important to eat well.

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T aking a multivitamin/mineral pill every day is a good idea if you have HIV. But taking more vitamins than

you need will not help your body fight HIV better. High doses of some vitamins and minerals can be toxic. Sticking to a balanced multivitamin every day is the best way to make sure you’re getting all the vitamins your body needs.

What About Vitamins?

When you take vitamins, try to:

■ Choose a vitamin that has 100% of the Recommended Dietary Allowances (RDA). Generic vitamins work just as well as name brands.

■ Read the label on your vitamins. Be sure you’re not taking more than 200% of the RDA (see the list below) of any one nutrient unless you’ve talked to your doctor.

■ Remember, a vitamin pill does not replace healthy eating.

If you’re vegetarian, talk to a dietitian about how you can make up for any nutrients you may be missing.

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Take your vitamins with food.

Don’t exceed thefollowing levels:

1,500 mg of Vitamin C5,000 IU of Vitamin A1,000 mcg of Selenium25 mg of Zinc2.2 mg of B61,000 mg of Niacin2,000 mg of Calcium (especially women)1,200 IU of Vitamin E25,000 IU Beta Carotene

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A lot of people don’t have a kitchen. When you don’t have a place to cook, it’s hard enough to think

about how you’re going to eat, let alone how to eat healthy. But there are still a lot of things you can do to eat well and stay healthy. Whether you shop at a super market, food pantry, or corner store you can still get the food you need without spending a lot of money.

Eating Well Without a Kitchen

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Take advantage of free grocery and meal programs, like Project Open Hand. Ask about “no cook” groceries.

Wash your hands before and after you eat. Wash or peel all fruits and vegetables.

If you don’t have a kitchen:

■ If you can, get a hot plate, electric kettle, toaster oven, small microwave, or refrigerator. You’ll have even more eating options.

■ Get a can opener, knife, and vegetable peeler.

■ Keep your living space as clean as you can. Store food in plastic bags or containers. Throw out leftovers. Keep food off the floor.

■ Eat one meal out every day. Burritos, pizza, and Chinese food can be healthy choices and don’t cost a lot.

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Eating Well Without a KitchenBuy foods that keep

at room temperature and will store longer, like

bread, cereals, crackers, canned beans, chili, soup,

fruits and vegetables, peanut butter, peanuts,

raisins, oatmeal, dry milk powder, and fruit (oranges

and apples keep well.)

NO cOOK MENU(When you don’t have a stove, oven or refrigerator.)

BREAKFASTplain bagel with jellyapplesaucedecaf coffee or tea1 can nutritional supplement

SNAcKenergy or granola barfruit juice mixed with water (1/2 juice to 1/2 boiled, filtered, or bottled water)

LUNcHtuna fish with celery and tomato sandwich on whole wheat breadbanana2 glasses filtered or bottled water

SNAcKapple bran muffin or pretzelspudding cup2 glasses filtered or bottled water

DINNER (EAT OUT)chicken or beef burrito with rice, beans, salsa, and guacamoletortilla chipslarge glass of milk or milk alternative

SNAcKraw carrot stickspeanut butter with crackers1 can nutritional supplement2 glasses filtered or bottled water

S ome people with HIV use drugs and alcohol. When you’re using, you’re more likely to lose weight,

which can weaken your immune system. But there are things you can do to cut down on harm to your body. Whether you’re in recovery or still using drugs and alcohol, it’s important to eat well.

Eating Well if You’re Using or in Recovery

Eating Well in Recovery

A lot of people with HIV are in recovery from drugs and/or alcohol. Drugs and alcohol can hurt your immune system. So, if you have HIV, getting into recovery is one of the best steps you can take to restore your body and positively affect your health. Eating well goes hand in hand with recovery and staying healthy with HIV.

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P O S I T I V E N U T R I T I O N1122

To support your recovery, it may help to:

■ Shop when you’re not tired or hungry. If you’re hungry, eat before you shop.

■ Plan your meals ahead of time.

■ Shop for food as soon as you get any money.

If you choose to use, try to:

■ Drink plenty of water.

■ Drink nutritional supplements.

■ Get some exercise.

■ Rest when you need to.

Eat before you use, especially protein like meat, tuna, beans, or cooked eggs.

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A Message to Caregivers

Here are a few suggestions that may help you help them:

■ Ask them what they’d like to eat.

■ Let them be part of shopping, cooking and choosing what food to eat.

■ When you can’t visit or help in person, call.

■ Shop for, fix, and eat food with them. Everyone likes company.

■ Buy items that are easy to fix like canned soups, stews, peanut butter, frozen dinners, potatoes, and sandwich items.

■ Take a break when you need to. You need to take care of yourself, too.

Thank You. Your support means a lot.

If you take care of someone who is living with HIV, you may have

questions about how you can help or if there’s anything special you

should be doing. It’s not always easy taking care of someone who has

HIV. There may be times when they need help or when there is nothing

you can do to help. Their needs may change from time to time.

Encouraging someone with HIV to eat the food they need to stay healthy

is important.

foodFor service or to speak

with a dietitian, call

1 800.551.MEAL

TEL 415.447.2300

FAX 415.447.2490

www.openhand.org

nutrition@openhand.org

Project Open Hand

730 Polk Street

San Francisco

Cal ifornia 94109