Nutritional support is essential to individuals with HIV/AIDS. Many HIV positive individuals have a difficult time maintaining proper nutrition due to a variety of conditions and complications associated with the disease and with medications prescribed for treatment. However, various nutritional strategies and some simple dietary modifications can help alleviate some of the complications associated with HIV medications.

The following information is part a of a series on nutrition and HIV symptom management, and is meant to be a general guide. Never disregard or delay seeking medical advice because of what you read. Always consult with a health care provider before changing your diet.

Further installments addressing fatigue and other HIV-related symptoms will be added to the series in the near future.

Toby Scala, RD, Nutritional Services Manager at LIAAC

Protease Inhibitor Diarrhea

Many HIV+ individuals who take protease inhibitors experience diarrhea. For some, changing highly active anti-retroviral therapy (HAART) therapy is not an option despite the discomfort. If you are on a protease inhibitor and experiencing this unpleasant side effect, talk to your doctor about the nutritional strategies below. They may help alleviate the diarrhea.

First, you should contact your doctor if diarrhea occurs three or more times per day and lasts more than two to three days. Your doctor will order a stool culture to test for parasitic or bacterial infections. The diarrhea caused by these infections is best treated through medication and not the nutritional suggestions below. If, however, the diarrhea is not from a parasitic or bacterial infection, the protease inhibitor you are taking may be irritating your gastrointestinal tract.¹ and the suggestions below may help decrease the diarrhea.

Soluble fiber tends to work well for this cause of diarrhea. For instance, the pectin (a form of soluble fiber) found in fruits may help alleviate the diarrhea. Cooked or canned fruits are recommended, as they are more easily digested than raw. Bananas, applesauce, canned peaches, fruit cocktail, or canned pears are all good choices. Start by eating three or more servings of these fruits daily. Also, oatmeal and cooked barley are good sources of soluble fiber.¹ Rice, white toast, noodles and saltine crackers may be better tolerated as well.

A bulk soluble fiber supplement may also be helpful. Psyllium seed (Metamucil) or Citrucel will add bulk to your stool.

Probiotics, friendly bacteria that normally inhabit the intestinal tract, may also help control the diarrhea. Probiotics work differently than antibiotics. Antibiotics kill all of the bacteria found in the gut, good and bad. Taking a probiotic supplement may help restore the good bacteria. The best supplements are a blend of bacteria. Good choices are Lactobacillus GG, Lactobacillus Acidophilus, Bifidobacterium Bifidum, Lactobacillus Bulgaricus.^1,2 Unfortunately, probiotics are currently not covered by Medicaid.

Yogurt is made from milk fermented by the friendly bacteria. Yogurt alone, however, does not provide enough bacteria needed to restore your own bacteria.

It is recommended to take a probiotic for one month to help alleviate symptoms. However, it may also be beneficial to take a probiotic supplement while on a prophylactic antibiotic, such as bactrim.¹ This is because antibiotics kill both good and bad bacteria found in the gut. Due to the expense, discuss with your doctor if this is an appropriate therapy for you.

L-Glutamine is an essential amino acid that repairs the lining of the intestinal tract cell (gut cells). People with HIV may experience glutamine depletion. Medicaid covers L-Glutamine. Ask your doctor if this is right for you.

Lactose, the sugar found in milk and dairy products, may not be digested properly when you have diarrhea. You may benefit from avoiding milk, ice cream, and American cheese. Yogurt and aged cheese such as cheddar, Swiss or Parmesan seem easier to digest.¹ Lactaid caplets and Lactaid milk can aid in digesting these foods as well.

Fat may be irritating your gut and worsen the diarrhea. With diarrhea the gut has a decreased ability to absorb nutrients. Therefore reducing your fat intake may help alleviate this side effect.

• Avoid fried/greasy foods
• Bake or boil instead
• Use butter, margarine and oil sparingly
• Remove visible fats from meat and skin from poultry
• If weight loss is a concern you may need to compensate by eating more carbohydrates and protein to maintain your weight.

Stay well hydrated. It is also important to replace fluids and electrolytes, which are lost during episodes of diarrhea. Avoid coffee and caffeinated sodas (they may dehydrate you even more). Drink throughout the day and less at meal times. Try beverages that provide water, electrolytes and calories such as:

• Diluted fruit juices: 50% juice/50% water
  (grape and cranberry are best tolerated)
• Diluted fruit nectars
• Soup/broth
• Sports drinks

Finally, if you have any questions I'll be happy to assist you. Just call the hotline at 1-877-TO-LIAAC (1-877-865-4222) and ask for Toby Scala, the Nutrition Services Manager.