Fat redistribution in people with HIV/AIDS is a problem that is gaining more attention. Medication-based therapies such as oral antidiabetic drugs, changes of antiretroviral therapy, growth hormone, and surgery have been tried, but the possibility of treatment or prevention using exercise and diet, while interesting and potentially important, has received much less attention. Lack of appetite, or anorexia, has long been associated with HIV disease. As the importance of nutrition to immune health has become better understood, appetite stimulation, nutrient control, and caloric intake have become increasingly important for maintaining overall health in the HIV-positive individual. A key factor in maintaining immune health, especially for diabetics, is the control of insulin resistance. With insulin resistance it is not so much that the body can't produce insulin (a necessary hormone for glucose metabolism), as that the body is resistant to its normal effects. The level of insulin in response to meals or snacks remains too high.

 

In the chart below, circle the column heading that shows the amount of calories you estimated in Step 1, and then circle each number in the column underneath that heading. Each number in the column represents the recommended number of daily servings of grains, fruit, vegetables, milk, and meat that someone in your specific calorie-target group needs to consume to maintain current weight, ensure proper nutrition, and control insulin levels.

Calories  1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200

    

Grains    4    5    6    8    9    10   11   12   14   15     16

Fuit 4    4    4    4    4    4    4    4    4    4    4

Vegetables     3    3    3    3    3    3    3    3    3     3    3

Milk 2    2    2    2    2    2    2    3    3    3    3

Meat 2    2.5  3    3    3    3.5  3.5  4    4.5  5    6

Then enter the serving numbers that you circled above in Step 2 into the first column of the following chart:

Food group     Serving examples (Each item represents a single serving) Comments

Grains    _______  servings    1 slice of bread, 1/2 bagel, 1 English muffin, 1 small tortilla,   Grains are a good source of carbohydrates, calories, and B vitamins. 

1/2 hamburger bun 1/2 cup cooked rice, pasta, cereal,    Whole grains are a source of iron,magnesium, selenium, and zinc.   

or potatoes, 4 to 6 crackers  

Fruit _______  servings    1/2 cup cooked or canned fruits, 1/2 cup fruit juice,     Fruit is a good source of carbohydrates, vitamins,

          1 cup raw fruit minerals, and especially antioxidants.

Vegetables _______  servings    1/2 cup of cooked vegetables, 1/2 cup of vegetable juice,    Vegetables are a good source of vitamins, minerals,

          1 cup raw vegetables and especially antioxidants.

Dairy _______  servings    8 ounces (1 cup) of milk or yogurt, 1-1/2 ounces cheese,      Dairy products are a good source of protein,carbohydrates,

          1-1/2 cup frozen yogurt/ice cream   B vitamins, and minerals.Use pasteurized products.

Protein   _______  servings    3 ounces of cooked meat, chicken, or fish, 2 cooked eggs,    Protein is a good source of B vitamins and minerals.

          1/2  cup nuts or tofu, 1 cup cooked dried beans, lentils, or peas     3 ounces of meat is about the size of a deck of cards.

To calculate your nutritional needs and to create a plan that will help with insulin resistance, simply follow these steps:

1. Let's say you're a man who weighs 160 pounds (and you want to maintain that weight). You may need 2,200 calories to do this, and so in Step 2

above you would circle all the serving numbers in the column under the number 2,200. In this example, we're focusing on your carbohydrate needs,

so you should add up all the servings from grains, fruit, and milk:

     _____ 10 grain servings + 4 fruit servings + 2 milk servings = 16 total carbohydrate servings/day

Now, using your target calorie number, locate your own recommended serving numbers from Step 2 and write them in below:

     _____ grain servings + _____ fruit servings + _____ milk servings = _____ total servings

2. Divide the total carbohydrate servings by the number of meals you plan to eat each day (at least 4). If you end up with an odd number, make that smaller number a snack. For example: 16 total servings / 4 meals or snacks per day = 4 servings of carbohydrates per meal or snack

Now make the calculation using your own serving numbers, as just listed above:

     _____ total servings / _____ meals or snacks per day = _____ servings per meal or snack

3. Now plan some ways that you can evenly distribute these carbohydrate servings throughout the day:

Example: Meal/Snack 1:  4 carbohydrate servings at (usual time of day): 9:00 a.m.

Meal/Snack 1:  _______ carbohydrate servings at (usual time of day): ___________ Meal/Snack 2:  _______ carbohydrate servings at (usual time of day): ___________

Meal/Snack 3:  _______ carbohydrate servings at (usual time of day): ___________ Meal/Snack 4:  _______ carbohydrate servings at (usual time of day): ___________

 

Finally, make your own individual plan. As shown in the Examples column below, to help control your insulin levels, make sure during each meal that you eat some food with protein or fat along with your carbohydrates. Once you reach your planned number of carbohydrates for a meal, save the other servings for later meals. Mark each carbohydrate serving with an asterisk (*). Some entries may represent more than one serving, as shown by a double asterisk (**) in the Example column.

Meal or snack  Example   My sample meal plan  Another sample meal plan

Breakfast:     4 carbohydrate servings: 2 eggs, 1 piece of toast,*  

1 cup of milk*, 1 cup of orange juice**      

Lunch:    4 carbohydrate servings: Ham sandwich**, Carrot sticks,

     2 ounce bag of pretzels**     

Dinner:   4 carbohydrate servings: 3 ounces of roast turkey, 1 cup of

     stuffing,**  1 cup of green beans, 1 large diced pear**      

Snack:    3 carbohydrate servings: 1 cup of yogurt*, 6 graham cracker

     squares,** 1/4 cup of roasted almonds

It is often difficult to maintain a therapeutic diet in HIV disease due to lack of appetite, fatigue, and numerous other co-morbidities.

However, neglecting the nutritional component of treatment can lead to insulin resistance, body fat changes, and variety of other problems.

See Cade Fields Gardner's bio below.