Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and Tuberculosis (TB) are two of the most prevalent infections in South Africa, and both conditions present nutritional challenges that must be met to effectively treat these diseases.
“HIV/AIDS and TB patients are not just eating to maintain their normal bodily functions, like moving their muscles and the pumping of their hearts,” says Chantell Witten, a registered dietitian and spokesperson for ADSA (Association for Dietetics in South Africa). “When you have a disease, it becomes even more important to maintain good nutrition because you often need additional energy and nutrients to effectively treat the disease, maintain a healthy weight, help the medication work optimally and support the body to repair damaged cells.”
According to Yzelle Watermeyer, a clinical dietitian working at the coal-face at the Kopanong Hospital in Vereeniging, one of the most serious challenges many patients face is the danger of getting caught up in a vicious cycle of malnutrition and an impaired immune system.
“Sickness and some medications can cause loss of appetite, malabsorption and an altered metabolism (increased nutrient needs). This, together with a lack of access to quality food may result in a vicious cycle of weight loss, decreased immunity and worsening of the chronic infection (HIV and/or TB).”
The significant link between healthy eating and wellness is at the heart of an ongoing Department of Health (DoH) message to broadly increase awareness that what we choose to eat and drink really matters. “South Africans needs to be empowered with the knowledge of how nutrition impacts on their health, and their lives,” says DoH Director of Nutrition, Rebone Ntsie. “With information and understanding, people can take responsibility for their wellness by making small lifestyle changes that can have a big impact.
"For instance, if you have money to buy a packet of chips as a snack; this money would be more wisely spent on fresh fruits which are packed with vitamins, minerals and fibre. If you have money to buy a fizzy, sugary drink; again you can make a better choice by choosing to drink life-giving water instead. You can reduce intake of unhealthy fat (saturated fats and trans fats) by buying a good quality piece of meat with no visible fat, grilled chicken or fish rather than fried ones. This is how every South African can make better food choices and improve their wellness, and it is particularly important to people living with HIV/AIDS and TB.” So, what should South Africans infected with HIV or TB eat?
The experts are unanimous that they don’t have do much that’s different from following the basic healthy eating guidelines that apply to all South Africans (as per our South African Food Based Dietary Guidelines
). Whilst, some medications may present challenges due to malabsorption and/or nutrition related symptoms, sticking to the rule of following a healthy diet made up of a variety of foods goes along way.
“As we would advise healthy individuals, it is equally important for those affected with HIV/ TB to eat a variety of foods that will supply their body’s with much-needed nutrients,” points out Witten. “Eat foods that are minimally processed which will provide you with a good dose of micronutrients (vitamins and minerals), as well as a good quality macro-nutrients (protein, carbohydrates and fats). We encourage everyone to eat plenty of fresh vegetables and fruits; wholegrains and legumes (such as beans and lentils); good quality meat, chicken or fish as well as eggs and unsweetened dairy products. These whole foods will help you manage the disease and build and repair damaged cells.”
Watermeyer emphasises that eating fermented, probiotic rich products like yoghurt or maas every day helps to support gut health, which is often compromised by HIV and TB. “Try to stick to the unsweetened/ plain dairy products because with infections like HIV and TB, patients have a propensity towards developing thrush. Adding excessive amounts of sugar to the diet may worsen this. So whilst sugar is energy dense and may help you gain weight, it should be consumed in moderation as it may worsen side effects and is considered a nutrient poor choice as it does not contain any additional vitamins and minerals to support the body,” she says. What foods should HIV and TB patients avoid?
- Avoid unpasteurised dairy products such as milk, yoghurt and cheese (always check the label if unsure, almost all dairy products sold in supermarkets are pasteurised, but milk bought directly from the farm, although more cost effective is not always pasteurised, so rather be safe than sorry!).
- Alcohol (increases risk taking behaviour and can exasperate malabsorbtion).
- Raw or partially cooked animal products (can be a source of potentially harmful bacteria like Listeriosis).
- Do not use anything past its expiry date.
- Limit tea and coffee as they affects some nutrient absorption and are not beneficial to the body (for example iron).
- Avoid sugary coldrinks and energy drinks (these are high in sugar and low in nutrients a.k.a nutrient poor).
Witten adds: “Avoid proccessed meats like polonies, viennas and corned tinned meats. Although you may think these taste good, they are often high in salt and saturated/trans fats which is not ideal for your health). If you can't afford fresh meat, chicken or fish every day, rather than buying processed meats daily, save up for a piece of good quality piece of meat once or twice a week and remember that legumes such as beans and lentils, eggs and tinned fish like sardines and pilchards are wonderful and healthy alternatives.” Top tips to help patients access safe, healthy foods that are more affordable include:
- Make a vegetable garden at home and grow your own fresh vegetables.
- Legumes (like beans and lentils), soya mince, eggs and tinned fish are fantastic sources of good quality protein.
- Shop at the most affordable stores, be price-aware and look out for the specials.
- Buying in bulk is often cheaper, share the cost and produce with family, friends and neighbours.
- Do not buy and eat cracked eggs (check them before you buy them).
- Be vigilant about keeping your hands and food preparation surfaces clean at all times.