Good nutrition in HIV has long been a focus for improving medication tolerance, relieving or preventing treatment side effects, and improving the function of the immune system. More recently, the focus has included the importance of nutrition and lifestyle changes for the treatment of metabolic abnormalities.

Metabolic abnormalities involve lipid and glucose metabolism as well as fat atrophy and accumulation. Lipid changes include elevated cholesterol levels, triglycerides, and increased low-density lipoprotein (LDL), the "bad cholesterol," with a lowering of the high density lipoprotein (HDL), the "good cholesterol." Dysregulation of glucose metabolism includes insulin resistance and impaired blood glucose tolerance. Fat atrophy and fat accumulation has been linked to glucose and/or lipid metabolism abnormalities.

A lifestyle approach can limit the need for lipid or glucose medications and in turn can limit further side effects and medication interactions.

Changes in glucose metabolism and hyperlipidemia are risk factors for heart disease. Other risk factors for heart disease include inactivity, hypertension, and cigarette smoking. Other lifestyle risk factors include excess alcohol consumption, obesity, and a high saturated fat/hydrogenated fat diet. Lifestyle changes including diet, exercise, weight loss (if overweight) are known to improve the insulin resistance of type 2 diabetics and to improve lipid values in hyperlipidemics. Making lifestyle changes can minimize the risk for heart disease. An important note: most of these changes have the added benefit of improving immune function.

Diet

A general guideline is to choose food in its most natural state. For example, whole grain foods such as wheat bread and brown rice in place of white bread and white rice.

Fiber

Increasing the fiber content of the diet will improve glucose tolerance and lower cholesterol levels. Changes in fiber content should be gradual to minimize bloating and diarrhea especially when these problems exist currently.

"     Add more whole grain breads, pastas, and cereals, and brown rice.

Fat

Decreasing the amount of saturated fat

and hydrogenated fat will promote improved

lipid levels. Saturated fats are found mainly in animal products including red meat, poultry skin, processed meats, fried foods, whole fat and 2% fat milk products, and high-fat cheeses. Hydrogenated fats are found more in foods that are highly processed, and shelf stable.

"     Add more soy-based protein foods (there are some great substitutes including soy hot dogs, low fat or fat free dairy products).

"     Use canola, soybean, or olive oils. Try the margarine(s) with plant stanols/sterols.

"     Use natural peanut butter.

"     Omega 3 fatty acids have been shown to lower cholesterol and increase HDL levels in many patients.

"     For best results, a daily intake of omega-3 oils is recommended. Incorporating 2 to 4 tablespoons of ground flaxseed daily in your diet is a good way to get omega-3 oils as well as to increase fiber.

"     Flaxseed can be put on cereals, salads, yogurt, or it can be eaten plain. Since it is high in fiber, increasing intake slowly is suggested to minimize initial, temporary problems with stomach gas.

"     Other sources of omega 3 fatty acids include cold water or fatty fish, such as tuna and salmon, and walnuts.

"     Sugar and sweets should be minimized to limit problems with glucose metabolism and triglycerides.

Exercise

Exercise is important to help with metabolic issues and to reduce stress. However, it is advisable for patients to check in with their primary care provider before beginning any exercise program. The two forms of exercise that can be beneficial include (a) aerobic activity such as brisk walks to increase the heart rate and strengthen the cardiovascular system and (b) anaerobic exercise such as resistance training to maintain and/or build muscle. Using resistance bands is good for training at home. The "no pain, no gain" motto is simply an exercise myth.

Smoking Cessation

Everyone knows how important it is to stop smoking, but this habit can be very difficult to break. Ask your healthcare provider to discuss the options for smoking cessation with you. Smoking is known to increase risk for heart disease and to lower HDL cholesterol.

Weight Loss

To prevent loss of lean body mass, it will be important to incorporate anaerobic exercise as well as aerobic exercise in any weight-loss regimen. The other important factor is making sure protein intake is adequate.

Living well with HIV disease involves a lot more than just taking anti-HIV medications. It takes a holistic approach that incorporates healthy choices and lifestyle changes to stave off or prevent the frequent long-term complications of HIV infection.

Gail Hansen, RD, LD is the dietitian at Clinic 42, a not-for-profit outpatient HIV/AIDS clinic at Abbott Northwestern Hospital in Minneapolis, MN, and the consulting dietitian for Park House and The Aliveness Project.