People with HIV can be more prone to stomach problems, particularly in the long-term.

When the virus first enters our blood stream, it has a significant effect on the gut microbiome where about 70% of our CD4 T-cells live in lymphoid tissue. Even when HIV treatment is successfully managing our viral load, T-cells in the bloodstream are less likely to return to normal levels in the gut due to the damage done. This means that the gut barrier is not as efficient, allowing fragments of bacteria to leave the gut where they are normally protected from the body inside gut walls, and move into the bloodstream causing inflammation.

While not a subject fit for polite conversation, dealing with chronic constipation and occasional bouts of diarrhoea has been my life in recent times. My other positive friends report bloating, excessive wind, sudden bouts of diarrhoea and nausea as well, so I know these problems are common. I have experimented with a range of antacids and foods like yoghurt to line my stomach, but symptoms persist.

So, I did some online research to see if there were any answers for those of us with HIV. I found that it is not straightforward.

In a recent paper titled HIV and its Long-term Impact on the Gut (1), Professor Sharon Lewin from the Doherty Institute with Heather Ellis from Positive Women Victoria refer to “microbial translocation”, where pieces of bacteria can cross the gut barrier. Good and bad bacteria come into the gut from food we eat, with the bad usually protected inside the barrier. A condition called “leaky gut syndrome” occurs when the gut barrier becomes permeable to toxins that leak into your bloodstream. Not all positive people have this problem but in those who do, it is thought to be the cause of metabolic disorders such as obesity, diabetes, arthritis, chronic fatigue syndrome and asthma, particularly in some older people with HIV.

Professor Lewin says there are no easy answers to protecting our gut permeability but emphasises that staying fit with lots of exercise, having a good diet, getting plenty of sleep and minimising stress are all important things to do. Many people with HIV manage to master this process well, with some of us long-termers facing the bigger task of countering any previous damage.

So, what should we eat?

We all have some idea of what constitutes a good, balanced diet. Fruit and vegetables; sources of protein like chicken, eggs or beans; the grains you get in breads and muesli; calcium from yoghurt and cheese; and healthy fats.

I spoke with Kathleen Shields, HIV nutritionist with the Alfred Hospital in Melbourne who said that there are no “superfoods” she can recommend for gut health in people with HIV but that we should all aim to improve heart health by eating plenty of healthy fats such as those found in olive oil, fish and avocado.

We’re all at a higher risk for heart attack, partly caused by these inflammatory processes and partly by the extra weight we may have accumulated, often as a result of antiretrovirals. HIV-related lipodystrophy is a particular problem for some of us long termers who have not been able to shift fat from the stomach area no matter what exercise we do, so sticking to a good diet is essential.

“I recommend the Mediterranean diet to my HIV-positive clients”, says Kathleen. “It concentrates on fruits, vegetables, and legumes, with little red meat consumed. It consists of healthy fats like olive oil and nuts (a handful every day) and limits butter, cream and foods like sausages. 

“For breakfast I suggest porridge and fruit, yoghurt and eggs as good options. You should have foods like fish for protein, grains for carbohydrates, and dairy to ensure you get your daily calcium for bone health. It doesn’t matter what order you eat those things providing you get all those foods in your day.

“Then there is the need for some people to regain muscle. This is partly down to exercise but also eating the right proteins. As well as fish, you could try foods like baked beans, four bean salads, dried peas, chickpeas, soybeans and peanuts. These foods will help with your kidney function as well.”

What about those of us with poor appetites?

Kathleen has some clients who have trouble with their appetites. Sometimes this is caused by opportunistic infections, thrush, pain swallowing or pneumonia—conditions more common in the early days but still around. For these people she tries to work out what foods they like to eat but often they get some success with protein drinks like Ensure or Sustagen.

“These days it is rare for people to need dietary supplements, particularly if they are eating a balanced diet”, she says.

The basics are: you need zinc (from seafood, poultry, nuts and seeds), selenium (from seafood, chicken and nuts), Vitamin C  (from fruits, vegetables and leafy greens) and Vitamin A (from liver, carrots and sweet potato).

Find an HIV dietitian

Most of us know that our diet is not perfect, but if we get it right most of the time with a few “treats” thrown in from time to time, dieticians say that’s okay. It does help to know what a healthy diet is in the first place. That’s when consulting an expert can help.

If you’re serious about making your gut more comfortable, find an HIV-experienced dietician through your local hospital (their ID or HIV clinic if they have one) or GP practice. Find one who can go through your diet and tick the foods you like to eat, the ones that are good for you, and any that will help you to reduce weight or improve your appetite, if either is an issue.

Sometimes it’s a matter of isolating the foods that don’t agree with you and working out the ones that are most beneficial for your long-term health. And finding the ones that you will enjoy the most. Good food should be a pleasure. So, above all else, enjoy.

Links

1. Professor Sharon Lewin and Heather Ellis, “HIV and its long-term impact on the gut”, Positive Women Victoria/your gut health webinar

Kathleen recommends Eat for Health, an Australian Government website for the basics of a good diet.

For an introduction to the Mediterranean diet on the Dietitians Australia website