Healthy eating for people living with HIV

Good nutrition is important for everyone’s health. Nutrition plays an important role in the health of the immune system and its ability to fight infection. Healthy eating also helps you become and stay a healthy weight, and can help reduce the risk of developing heart disease, diabetes, cancer and osteoporosis.

Having HIV doesn’t mean that you have to make big changes to your diet. But eating the right foods can make you feel better, have more energy and can keep your heart and bones healthy as you get older.

If you have concerns or questions, your clinic will usually be able to put you in touch with a dietitian. Dietitians can also help you to manage your weight or problems like high cholesterol, or manage any side-effects from HIV treatment that affect how you eat (like nausea or diarrhoea). Side-effects from HIV treatment are often mild and lessen or go away completely with time.

For most people living with HIV, good nutrition is the same as it would be for anyone else.

A good diet will consist of a balance of the following types of food:

• Starchy foods
• Fruit and vegetables
• Dairy products or alternatives
• Beans, pulses, nuts, fish, eggs and meat
• Unsaturated oils and spreads.

Foods that are high in fat and sugar should be eaten less often and in small amounts.

Starchy foods include bread, cassava, cereals, green banana, millet, maize meal, potatoes, pasta, couscous, rice and yam. Starchy foods should form the basis of your diet – about a third of your food intake each day. They provide carbohydrates for energy, fibre, calcium, iron and B vitamins.

If you have a gluten allergy or coeliac disease and need to exclude gluten from your diet, there are many gluten-free versions of foods available including pastas and breads.

Try to choose wholegrain versions over refined carbohydrates where possible. Wholegrain versions of rice, pasta, couscous, cereals and bread contain more fibre and often more vitamins and minerals as well. Leaving skins on potatoes can also help to increase your fibre intake.

A diet high in fibre helps digestion and may reduce the risk of developing heart disease, type 2 diabetes and bowel cancer.

Fruit and vegetables provide vitamins, minerals and fibre. Like starchy foods, they should make up a third of your daily food intake. Try to eat five or more portions of fruit or vegetables each day. A portion is 80g, or roughly equal to:

• one medium-sized piece of fruit (such as an apple, pear or orange).
• two small pieces of fruit (such as a satsuma or plum).
• a large slice of a larger fruit such as pineapple.
• three heaped tablespoons of vegetables (these can be fresh, tinned or frozen). Vegetables such as potatoes and yams do not count towards your five-a-day target as they are counted as starchy foods.
• three heaped tablespoons of beans or pulses (these only count towards one of your five-a-day target, no matter how many portions you eat).
• a handful of dried fruit (30g) or a small glass of fresh fruit juice or a smoothie. Like beans and pulses, juices and smoothies only count as one of your five-a-day target even if you drink more than a glass. Fruit juice is very high in natural sugar as juicing or blending fruit releases the sugar so it becomes ‘free sugar’.

Fruit and vegetables can help protect against certain cancers and heart disease. They are low in fat, so increasing the proportion of your diet made up of them is helpful if you are trying to lose weight. It is also a good idea to eat a variety of fruit and vegetables as different types provide different vitamins and nutrients.

Dairy products, such as milk, cheese and yoghurt, provide vitamins, minerals and particularly calcium. You should include some dairy, or dairy alternatives, in your diet. Some dairy foods are high in saturated fats, so should only be eaten in small quantities, or you could choose lower-fat versions of milk, cheese and yoghurt.

If you avoid dairy products, then these can be replaced with fortified soya, nut, rice, oat or coconut alternatives. Check the nutrition labels as not all of these alternatives are fortified with calcium, and organic products rarely are.

It is a good idea to try and get your calcium from a range of sources rather than just rely on dairy products. Dark green leafy vegetables like kale, Chinese greens (e.g. bok choy), broccoli, dried fruits, nuts, beans such as soy and baked beans, tofu and bread are all very good sources of calcium and also iron.

Fish that contain bones that you eat (e.g. sardines, pilchards and whitebait) are also good sources of calcium.

Beans, pulses, nuts, fish, eggs and meat provide protein, minerals and vitamins (particularly iron and B12 from meat). You should eat some of these protein-rich foods as part of your diet.

Other non-animal based protein options include quinoa, soya, tofu, Quorn products and vegetable protein. Pulses (beans, lentils and peas) are a great source of cheap and low-fat protein.

You could benefit from eating two portions of fish a week, including at least one portion of oily fish. Oily fish contains omega-3 which has anti-inflammatory properties and can also help prevent some heart problems.

The Department of Health has advised that people should eat no more than 70g of red or processed meat a day, due to the risk of bowel cancer. Both processed and red meat have been linked with other cancers too – red meat with pancreatic and prostate cancer and processed meat with stomach cancer. Some meats that are high in fat can also raise cholesterol.

Therefore it’s a good idea to eat a variety of protein-rich foods rather than just rely on red or processed meats.

Fats from cooking oils, margarine and spreads provide energy, essential fatty acids, such as omega-3, and fat-soluble vitamins (A, D, E, K). Try to eat ‘unsaturated’ fats, such as those found in nuts and seeds, avocados, olive oils and vegetable oils and oily fish. The ‘saturated’ fats, found in meat, cheese and butter can raise cholesterol. Other foods high in saturated fats include cakes, biscuits and pies. These should only be eaten in small amounts.

"Eating the right foods can make you feel better, have more energy and can keep your heart and bones healthy as you get older."

Food and drinks high in fat or sugar should only be a small part of your diet. They can contain empty calories and provide little or no nutrients. Too much of most sorts of food – but especially fats and sugars – can lead to unhealthy weight gain. Sugary foods can also lead to tooth decay.

Salt and salty foods can lead to high blood pressure, if eaten in large amounts, and this can increase the possibility of having a stroke or developing heart disease or kidney problems. Adults and children over eleven should eat no more than 6g of salt a day, and younger children less.

Some foods are high in salt (e.g. bacon, cheese, crisps, anchovies, gravy granules and stock cubes, ham, prawns, salami, salted and dry-roasted nuts, smoked meat and fish, salt fish, olives, soy sauce and yeast extract). Try to eat these less often or in smaller amounts and choose reduced-salt or ‘no added salt’ varieties of food where possible.

Bread and breakfast cereals can add a lot of salt to your diet, especially if you eat them frequently. Breakfast cereals can also contain a large amount of sugar. Where possible, also check the labels of foods such as sauces and dressings, crisps and tinned foods and choose varieties with lower levels of salt and sugar.

Reduce the amount of salt you use in cooking. You could use more spices, herbs, garlic and lemon to add flavour, for example.

Ready-made meals and other convenience foods are often high in salt, sugar and fat. Eating these too often can make it hard to have a healthy and balanced diet.

It is important to stay properly hydrated to ensure that the body has enough fluid (liquid) to function properly. It is recommended that people drink 6 to 8 glasses a day of fluids. Water, lower-fat milks, and sugar-free drinks, including tea and coffee, all count. Fruit juice also counts but should be limited to 150ml a day.

If you have a fever, or have diarrhoea, then it is important to drink extra fluids. Similarly, if you are exercising, you should increase your water or other fluid intake.

You can find out more about eating a balanced diet on the NHS Choices website.

Superfoods and fad diets

Superfoods are foods that some people believe offer increased nutritional benefits and even help with or cure some medical conditions and are often consumed in large quantities. These include blueberries, goji berries, broccoli and wheatgrass. There is not enough evidence to support these claims and it is better to eat a variety of foods rather than focus on one particular food.

Fad diets are diets that claim to help you lose weight quickly by following a very restricted diet. However, these diets can create health problems. If you do want to lose weight, it is better to do it slowly by choosing healthy options, and smaller portions of foods, and exercising regularly.

Vitamins, minerals and supplements

Most people, including people living with HIV, can get all the vitamins and minerals they need by eating a balanced, varied diet that includes plenty of fruit and vegetables. HIV specialists advise that there is usually no need for supplements. Read our Vitamins, minerals and herbal supplements page for more information.

Eating well on a budget

If you are having difficulty affording food, or buying food that you need for a special diet, a member of your healthcare team can put you in contact with sources of help.

The website www.moneysavingexpert.com has some useful advice on budgeting and shopping carefully. The NHS Choices website has a helpful list of 20 tips to eat well for less.

Here are some tips to help you shop and eat well without spending a lot of money:

• Small shops and convenience stores are often more expensive than larger supermarkets.
• Many supermarkets offer large packs of foods that keep a long time (e.g. rice) for less money per kilo than smaller packets. This can save you a lot of money in the long term. You could buy larger bags of rice or flour and split them with a friend or neighbour.
• Larger supermarkets have ‘value’ ranges to help reduce the cost of regular items used every day. And you can often save money on fruit, vegetables and staple foods at the cheaper supermarkets.
• ‘Value’ and other cheaper varieties of vegetable oil are almost all made from rapeseed, and are just as healthy as more expensive olive oil.
• Check ‘best before’ or ‘use by’ dates – sometimes food near this date will be reduced in price, especially towards the end of the day. But make sure you can use it before it goes off.
• Look for special offers on food that will keep, such as pasta, rice or cereals. But beware of offers in supermarkets that might tempt you to buy things you don’t really need.
• Fruit and vegetables are often cheaper if you buy them loose, rather than packaged, and if they are in season. They can also be cheaper, and better quality, if you buy them from a market or convenience store rather than a supermarket (and you may find a greater variety of foods from different cultures in some markets). But be careful not to buy more fruit or vegetables than you can use before they go bad, as you may have to throw them out.
• Frozen, tinned or dried fruit, vegetables and beans are nutritious, last longer and can be much cheaper than fresh. Tinned fish is also a good option. Try to choose the types with little or no added salt or sugar, and buy tinned fruit in juice rather than syrup.
• Making meals at home (such as lasagne, shepherd’s pie or curry) will often be cheaper – and healthier – than buying a ready-made version, especially if you are cooking for several people. You can also freeze leftovers of many meals.
• Foodbanks are available for those who find it difficult to afford food. You can ask your clinic or GP for more details.
• Plan your shopping, try to stick to your shopping list, and try not to go shopping when you are hungry!

Dietitians

You can get advice on nutrition from a specially trained health professional called a dietitian. Some HIV clinics have specialist dietitians or can refer you to them. Dietitians working with people living with HIV must be trained to achieve a high level of competencies as set down by the British HIV Association.

Dietitians can:

• Make sure your diet is fulfilling all your individual nutritional requirements.
• Give you advice about your diet if you are experiencing metabolic changes due to your HIV treatment.
• Regularly check your body weight and ensure that the proportion of fat to muscle is appropriate.
• Advise you on any dietary changes you may need to make if you become ill.
• Help you avoid food poisoning.
• Offer advice on symptom control, such as how to manage changes in taste caused by medication.
• Give advice for managing conditions such as diabetes, obesity, hyperlipidaemia (high levels of fat in the blood) and poor absorption of food.
• Give advice on your nutritional requirements during pregnancy.
• Help you identify and manage any food allergies and intolerances.
• Advise you on your nutrition needs based on your exercise levels or sporting activity.
• Provide information and advice on the use of vitamins and minerals and complementary therapies.

Some dietitians use a variety of tests to assess how much muscle and fat there is in your body. If these tests are done regularly your dietitian may be able to spot changes in weight and body composition before you do. However, you may be the first to notice changes in your weight or body shape – for instance, if your clothes become too loose or tight. These may be important times to talk to your dietitian about making changes to your diet or exercise.

Related information

You might also find the following information helpful:

• Food requirements for anti-HIV medications
• Unintentional weight loss and HIV
• Food and water safety for people living with HIV
• Weight gain and HIV treatment (a research briefing)