Making the best food choices for HIV & TB

Chat Leave a comment May 2, 2019 nutritionadsa

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 basic healthy eating guidelines as per our South African Food Based Dietary Guidelines apply to all, regardless of your HIV or TB status. 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 a long 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?

Watermeyer says:

• 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 malabsorption)
• 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 affect 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 processed 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 sardine’s 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.

ABOUT ADSA

ADSA, the Association for Dietetics in South Africa, is one of the country’s professional organisations for registered dietitians. It is a registered non-profit organisation served by qualified volunteers. The Association represents, and plays a vital role in developing the dietetic profession so as to contribute towards the goal of achieving optimal nutrition for all South Africans. Through its network of ten branches ADSA provides dietitians with the opportunity to meet and network with other professionals in their provinces. Through its comprehensive Continuing Professional Development (CPD) system, ADSA supports dietitians in meeting their mandatory on-going learning, which is essential to maintain their registration status with the Health Professions Council of South Africa (HPCSA).  Visit: http://www.adsa.org.za

‘Making a contribution to the bigger health picture’

Chat Leave a comment September 8, 2017 nutritionadsa

We chatted to Neil Stephen, Chief Dietitian at Addington Hospital in Durban, to find out why he became a dietitian, what he loves about his work and what the challenges are:

Why did you become a Registered Dietitian?

I developed an interest in nutrition when someone at the gym suggested I should see a dietitian to improve my performance.  I asked my parents if they knew of any dietitians and they told me that my cousin Nathan was one.  Later I decided to change from a general BSc to BSc Dietetics.  I was going to pursue a career in sports nutrition… which is the last thing I am interested in now.  To my surprise I was one of very few males in the class,  I had no idea that dietitians were mostly female!

What do you enjoy most about the work you do? What are the most satisfying moments?

I have quite a diverse range of areas I really love.  Top of the list is child health, followed by critical care, maternal health, student training and lastly, monitoring and evaluation of health systems and programmes (I’m a bit of a nerd).  I work daily with patients who have very little or nothing.  These patients are so humble and appreciative of any assistance you give them, whether its counselling or treatment.  The most satisfying moments are when I bump into moms with their young children or babies, who stop me, and they proudly tell me they are still breastfeeding. Another is when an acutely ill malnourished child improves over night and I know that nutrition has greatly contributed to the positive outcome.  Finally, its awesome speaking to previous interns and finding out they are succeeding at what they do. 

What has been your career highlight?

Well I started to collect data on every patient I treated when I started working.  I had a good amount of information per patient.  I put together a cool spreadsheet in excel to do my monthly stats for me, and eventually got my whole department on to it.  After a few years I decided to study further and used the information I had been collecting over the years.  So a highlight was definitely that I was selected to present my research for the MEC and Head of the KZN Department of Health.  Being selected really made me feel like I was valued and was making a contribution to the bigger health picture. 

What are the most challenging aspects of your career?

I think that for me its been a long journey of challenges and realisations which have grown me into the dietitian I am today.  Working in the public sector, I experience first hand the outcomes of social and economic  issues that face the general population on a daily basis.  It is heartbreaking to find that children are severely malnourished purely because they have a limited access to food.  A large proportion of patients of all ages are referred for HIV related problems which are often hard to manage and outcomes may be poor.  I need to mention that I love pregnant moms, children, and critically ill patients because they almost always accept advice and are compliant – the challenge is the patient who is resistant to change, because they don’t embrace the importance of lifestyle and dietary change.

How do you cope after a day of nutrition disaster and bad eating choices?

Hahaha, I usually just take a nap.

What are the three things that you think people should stop saying when they meet a dietitian?

• How can I lose the fat on my….(insert body part!!)???
• Isn’t there some kind of a pill or something I can take??
• I don’t eat carbs.

What should clients look out for when deciding which dietitian to work with?

Dietitians are all equally qualified to treat any patient presented to them.  If you have a specific need, some dietitians will list their special interests, one of which you may be looking for. 

What is your favourite dish and your favourite treat food?

• Favourite dish – Butter Chicken Curry with garlic butter naan bread
• Favourite treat food – chocolate mousse (I can eat it by the litre)

 

Read more about the career of a registered dietitian: Is a career as a dietitian for you?