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Problems with food

hand pushes cereal bowl away

When you're living with HIV, several factors might affect the way you eat. Appetite loss, diarrhoea, nausea, tiredness, mouth infections, illness or financial issues can be detrimental to the quality of your diet.

Some of the things that lead to problems with eating can be caused both by HIV itself and by antiretrovirals.

If you’re living with HIV, you might at some point experience:

You should also be aware of food safety issues (especially if your immune system is in bad shape) and ways of eating healthily on a budget.


Appetite loss

Lots of people with HIV experience a loss of appetite at some point.

Depression and liver problems - such as hepatitis - can cause it as well.

Here are some tips to help you deal with appetite loss:

  • Eat small snacks throughout the day rather than two or three large meals.
  • Avoid preparing foods with strong smells.
  • Eat nutritious foods rather than ones high in sugar and fat.
  • Keep healthy snacks at hand.
  • Use nutritional supplement drinks or energy bars.

If your appetite loss persists talk to your HIV doctor - they might prescribe some medication or check whether you need any more tests.


Diarrhoea

Diarrhoea is a need to urgently pass stools (poo) which are liquid or loose. It is often accompanied by stomach cramping, nausea, loss of appetite or a headache.

Diarrhoea in people with HIV is often caused by infections or side effects of antiretrovirals (or antibiotics). It can also be caused by HIV itself.

Side effects like diarrhoea and nausea often begin when you first start taking a drug, but they don’t usually last long.

Diarrhoea can also lead to dehydration, so it is important to drink plenty of water - NHS Choices recommends taking small, frequent sips.

Dehydration can lead to poor absorption of nutrition from food and of active ingredients from medication.

  • If your diarrhoea is caused by HIV affecting your gut, antiretrovirals will help.
  • If your diarrhoea is caused by antiretrovirals, it may pass once you get used to your medication. If not, your doctor may prescribe additional drug to manage the diarrhoea.

Ongoing or severe diarrhoea is a sign that you should see your doctor so they can carry out tests.

What is the best way to deal with diarrhoea?

  1. Keep hydrated by having regular sips of water (in general, women are advised to drink eight 200 ml glasses of water per day; men should drink 10). Fruit juice and hot drinks can also count towards your total.
  2. Eat small, regular meals as soon as you are able to.
  3. Avoid fatty and spicy foods.
  4. NHS Choices recommends snacking on bananas, potatoes, boiled vegetables, rice and soup.

There is also medication that can help with diarrhoea - it can be bought over the counter or prescribed.

If you have a high temperature or blood in your stools contact your GP or HIV doctor immediately.


Nausea

Nausea in people with HIV can be caused by a range of things: it can be a side effect of medication or a symptom of an infection.

Other common causes of nausea are:

  • anxiety,
  • morning sickness during pregnancy,
  • food poisoning (this will usually be combined with diarrhoea).

Here are a few simple ways to manage nausea:

  • Sip water regularly to avoid becoming dehydrated.
  • Ginger supplements, biscuits or tea can help reduce nausea.
  • Fruit juice can help replace the lost sugar.
  • Avoid fatty or greasy food.
  • Salty food like crackers can help.
  • Try eating little and often.
  • Eat sitting up and don’t lie down for at least an hour afterwards.
  • Ask someone else to cook for you if cooking smells make you feel worse.
  • Try using a symptom diary to keep track of which foods trigger your nausea.

Contact your doctor immediately if you:

  • are vomiting for more than a day or two,
  • can’t keep down your medication
  • see blood in your vomit.

NHS Choices has further information on nausea and vomiting and when to seek emergency help.


Food and water safety

It used to be the case that people living with HIV were more likely to get food poisoning or have problems caused by water impurities. This is no longer the case, as long as your immune system is healthy and strong.

If your CD4 count is below 200 or you are travelling abroad, your clinician will be able to advise you of any special measures you need to take regarding drinking water.

If your CD4 count is below 200 you might also need to be especially careful when preparing and handling food.

To avoid food poisoning:

  • Cook food thoroughly and check that it's steaming hot all the way through.
  • Make sure poultry, pork, burgers, sausages and kebabs are cooked until steaming hot, with no pink meat inside.
  • Wash worktops with hot soapy water.
  • Wash your hands before handling food and after touching anything raw - including meat, fish, eggs and vegetables.
  • Use separate chopping boards for raw food and ready-to-eat food.
  • Keep raw meat separate from ready-to-eat food.
  • Wash eggs before using them and do not use cracked ones.
  • Avoid unpasteurised dairy products.
  • Avoid raw shellfish.

Mouth or throat infections

HIV can cause infection in the throat, gums and mouth, making it extremely painful to eat.

To overcome this problem you could try eating soft foods or mashing and blending food to make it easier to swallow.

1. Eat smoothly textured foods:

  • Mashed potatoes instead of roast potatoes or chips.
  • Minced meat instead of roast meat.
  • Steamed fish instead of battered fish.
  • Soft fruits like berries and banana instead of apples and pears.

2. Avoid foods that might stimulate the lining of your mouth:

  • citrus fruit,
  • peppery food,
  • vinegar.

3. Consider using a straw to drink liquids.


How can I eat healthily on a budget?

  • Buy frozen fruit and veg.
  • When cooking a meal, make extra and freeze the rest for another day or have it for your lunch the next day.
  • Visit the supermarket when food prices are reduced - you can pick up lots of tasty bargains this way.
  • Buy cheaper cuts of meat - chicken legs or a whole chicken are more economical than chicken breasts.
  • Tinned oily fish is usually cheaper than fresh fish.
  • Make a shopping list for the week and stick to it.
  • Shop when you’re feeling full – you’ll be less likely to pick up unhealthy and overpriced treats, or products that are not on your list.
  • Consider having meat-free days – cook lentils, chickpeas, beans, rice and pasta and some tasty vegetables.

Other resources:

 

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The Information Standard: Certified member

This article was last reviewed on 14/1/2016 by Anna Peters

Date due for the next review: 14/1/2019

Content Author: Kerri Virani

Current Owner: Kerri Virani

More information:

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Treating diarrhoea , NHS Choices, 26/11/14

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Ten ways to prevent food poisoning, NHS Choices, 28/11/14

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Tiredness and fatigue, Michael Carter, Greta Hughson, NAM/Aidsmap, 23/5/12

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