>From: hivinfo@itsa.ucsf.EDU (Michael Howe) >Subject: VAMC NEWS SERVICE >Date: Thu, 23 Dec 1993 18:20:30 GMT AIDS NEWS SERVICE Michael Howe, Editor, MSLS AIDS Information Center VA Medical Center, San Francisco (415) 221-4810 ext 3305 December 24, 1993 Optimizing Oral Nutrition in AIDS ---------------------------------------------------------------- Table 1: Overcoming nutritional problems in HIV/AIDS ---------------------------------------------------------------- Anorexia o Eat small, frequent meals every 2 or 3 hours on a schedule; treat food as you do medications by keeping to the schedule. o Maximize caloric intake by keeping nutrient-dense snacks and drinks such as dried fruit, cheese and crackers, peanut butter and jelly sandwiches, cereal, yogurt, milk, fruit nectars, and commercial breakfast drink mixes readily available. o Take nutrient-dense dietary supplements or drink commercial quick breakfast preparations mixed with whole milk. o Try a walk before eating to boost appetite. o During periods of anorexia, concentrate on favorite foods. You're likely to eat more. Nausea/vomiting o Consider discussing with your doctor altering the timing of medication doses to after meals. o Avoid having solid and liquid foods at the same meal. o Dry, salty foods (crackers, pretzels) are usually easily tolerated. o Try simple foods: rice, scrambled eggs, toast, noodles, bananas, masked potatoes, custards, ice cream. o Allow plenty of fresh air in the house. Disperse cooking odors. ---------------------------------------------------------------- Table 2: Boosting calories and protein ---------------------------------------------------------------- o Dice cheese and meat; add to scrambled eggs, salads, and soups. o Use whole milk in preparing custards, puddings, cream soups. o Add powdered milk to whole milk to make double-strength milk for gravies, casseroles, baked goods, meat-loaf, hot cereals, mashed potatoes, eggs. o Add high calorie foods like butter, mayonnaise, and gravy to boost calorie count. o Add whipped cream to frosting and desserts. o When thirsty, drink milkshakes, nectar, eggnog. o Add dried fruit to pancakes, cereals. o Snack on: trail mix, nuts and seeds, peanut butter on crackers, bagels with cream cheese. Diarrhea o Drink plenty of fluids to avoid dehydration. o Eat small, frequent meals, and don't skip meals. o To replenish sodium and potassium, eat bananas, potatoes, fish, and meat, and drink apricot, nectar, tomato juice, and sports drinks. o Avoid high-fiber foods with "insoluble fiber": wheat bran, brown rice, popcorn. o Try "soluble fiber" foods: white rice, oatmeal, applesauce, pears, mashed potatoes. o Avoid greasy, fried foods. o Avoid sorbitol (a sweetener used in some chewing gums and candy). Too many sweets can also aggravate diarrhea. o Avoid gas-forming foods: kidney beans, lentils, broccoli, corn, onion, garlic. o Try lactose-free products from the supermarket, or take lactase (trade name Lact-Aid, usually available in the dairy aisle), the enzyme that allows digestion of lactose. Mouth sores/painful swallowing o Drink apple juice, fruit nectar, milk. o Avoid carbonated beverages, and salty or acidic foods. o Choose soft, moist foods: mashed potatoes, macaroni and cheese, casseroles. o Drink liquids through a straw. o Use melted butter or gravy to soften foods; dunk bread, sandwiches, crackers in teas or soup. ---------------------------------------------------------------- Table 3: Maintaining kitchen hygiene ---------------------------------------------------------------- o Keep shelves, counter tops, refrigerator, freezers, utensils, sponges and towels clean at all time. Wash sponges and towels after each use if possible. o Wash all utensils and your hands with soap and water after handling one food and before handling another. This helps prevent cross-contamination. o Use different cutting boards for foods intended to be served raw than for foods that will be cooked. While cooking may kill organisms in, for example, raw meat, a salad subsequently cut on the same board may pick up the organisms and be eaten raw. o Wash all fruits and vegetables. Use a vegetable brush to remove residues. o Thaw meats in the refrigerator rather than room air. o Keep refrigerator temperature 40 degrees Fahrenheit or lower. o Cook meats to at least 140 degrees Fahrenheit. Health care providers are authorized and encouraged by the publisher (Massachusetts Medical Society) to copy this patient information sheet for display or for distribution to patients. Source: Caremark, Inc., Lincolnshire, IL. Reprinted in AIDS Clinical Care. 1993 November;5(11):89. Note: The featured topic in this November issue of AIDS Clinical Care is "Nutrition and HIV Infection." ***************************************************************** Food Safety You have to be careful with food when you are infected with HIV. There as germs on all the food you bring home from the grocery store. You need to handle the food right, cook it right and store it right to kill those germs. The following tips provide advice about keeping food and cookware safe and clean. o Wash all fresh fruits and vegetables thoroughly. Use a vegetable brush designed for this purpose. o Throw away any fruit or vegetable which has a rotten or moldy spot on it. o Cook meat thoroughly. You might want to buy a meat thermometer to help you know for sure that it is done. Put the thermometer in the thickest part of the meat and not touching a bone. Cook the meat till it reaches 165 to 212 degrees on your thermometer. o Do not eat raw meats or fish, even in small amounts. No sushi or rare steak. Order restaurant meats cooked well-done. o Thaw frozen meats and other frozen foods in the refrigerator or in a microwave oven set to defrost. Never thaw foods at room temperature. Germs that grow at room temperature can make you very sick. o Don't eat raw eggs. Cook all eggs until firm. Don't eat Caesar salad. It contains raw eggs. If you wish to add and egg to a milk-shake or make egg nog, use a pasteurized product like "Egg- beaters." o Don't use cracked eggs. Look for cracks in the shell before you buy them. o Throw away moldy cheese. It is not good enough to just cut off the moldy part. o Don't let hot foods cool down at room temperature. Put them in the refrigerator right away. If it is a large amount o food, put it in 2 or 3 containers so the refrigerator can cool it all quickly. o Keep your refrigerator cold. You might wish to get a refrigerator thermometer. Keep it set no higher than 40 degrees. Your freezer should be at 0 degrees. o Use hot, sudsy water to wash your dishes. Let it out of the sink when it gets dirty and replace it with new. Any food germs left on your plate can make you. o Keep everything clean. Clean your counters often and clean them well. Wash your hands with soap and water a lot during cooking. o Don't use foods past the recommended date on the label. Even though this never made you sick in the past, it may now! o Don't taste anything that you think might be spoiled. If in doubt, throw it out! o Use pasteurized milk only. This means it has been treated with heat to destroy harmful germs. Look for the word "pasteurized" on the label. Do not drink milk fresh from the cow! o If you have old dishes, cups or plastic containers with a lot of scratches in them, throw them out. Germs love to hide in scratches and they are very difficult to clean out of there. o Wear rubber gloves when handling raw meat. This will prevent germs from entering any open cuts or sores on your hands. o Hurry home from the grocery store! If the cold or frozen foods warm up in your car, germs can grow that may make you sick later. ***************************************************************** Hints for Helpers This is a list of ideas for the person who helps a friend with meals. o Make casseroles and freeze enough for one meal in little plastic containers. Easy to defrost, heat and eat! o Thoroughly cook meats such as chicken, pork chops, hamburger, turkey, or roast beef. Chop and freeze small portions in little plastic containers or plastic bags. Easy to defrost and add to soups, salad, and casseroles to make them high in protein. o Hard-boil a dozen eggs. Do not peel. They will keep in the refrigerator for a week and can be used for snacks, or chopped and added to soups, salads and casseroles. o Volunteer to go grocery shopping. Buy foods that will make easy meals. o Take your friend out to a restaurant for a meal. There's something very nice about sharing your home with someone. o Plan a picnic for your friend. Pack up health food and go to the park, or even to the backyard! Sunshine and fresh air do wonders for the appetite. o Get food from a take-out restaurant. When we're ill it's difficult even to go down to the corner of the block by ourselves. o Provide company at mealtimes. We eat more when there is someone to talk to. o Share your favorite recipes, especially for simple, healthy things. Maybe you have a cookbook full of good ideas. o Share your appliances. Maybe you have a blender, toaster oven or microwave that you aren't using much. o Wash dishes. A dirty kitchen can really discourage cooking. a sick person may not feel up to cleaning. o Write out a few days of menus. Sometimes we all need help with planning. o Make a batch of healthy muffins or cookies. o Write out shopping lists of things that are needed in the kitchen. It takes energy to look on all the shelves and cupboards to see what's missing. o Be supportive. Don't be upset if your friend can't eat much today. Ask about favorite foods. Offer small servings of food. You can always provide seconds. Note: The preceding two sections were reprinted from: Wickwire PA. Nutrition and HIV: Your Choices Make a Difference. Tennessee Department of Health AIDS Program. Tennessee Hospital Association. Initial printing sponsored by the Tennessee Office of the East Central AIDS Education and Training Center (ECAETC). Copyright 1990; 5th printing. You are encouraged to copy this material as needed. ***************************************************************** Nutrition and HIV (Audiovisual Review) Author: Larry Waites, MD, MPH and Laurie Mello, RD Producer: North South Films Description: 1/2 in. videocassette, LIFETAPES Series (Vol. I), 20 min., 1992, $145 Target Audience: Persons with HIV Infection and Caregivers Synopsis: Dr. Waites and Ms. Mello provide information for maintaining good health in persons with HIV. The presentations are divided into four sections. These include: (1) nutrition, weight loss and the immune system in which Dr. Waites discusses impaired food intake, increased nutrition requirements, and decreased nutrient absorption; (2) overcoming poor nutrition includes maintaining proper weight, fortifying the diet, and controlling diarrhea; (3) eating defensively covers food preparation, foods to avoid, shopping and preparing foods, eating out, and traveling guidelines; and (4) an introduction to Total Parenteral Nutrition (TPN) which is carbohydrates, fats, proteins, vitamins and minerals given intravenously to provide nutritional support. At the end of each section, the information is summarized. Demonstration of food preparation is provided. Presenters' comments are provided on- screen. Bibliographic references are listed at the end of the program. Evaluation: This video is the first in a series of tapes designed to educate persons with HIV and their caregivers with information about nutritional support. A visual index system assists the viewer in relocating information within the tape. A section number is always visible in the lower right hand corner and key phrasings are repeated in a blue bar in the lower third of the screen. By scanning the tape, a specific section or demonstration can be found easily. The last section of the program only provides a definition of TPN and the third section, eating defensively, is based on the FDA videotape of the same title. This video is unique, however, in that few programs are devoted to nutritional support for the target audiences. This will be a valuable addition to collections within medical facilities for patient education and for those who provide nutritional support. Availability: Pyramid Film & Video, P.O. Box 1048, Santa Monica, CA 90406. Telephone: (800) 421-2304. Reviewer Info: Michael Howe, AIDS Information Center, Library Services (142D), VA Medical Center, 4150 Clement Street, San Francisco, CA 94121. Telephone: (415) 221-4810 ext 3305. FTS (700) 470-3305. Internet address: hivinfo@itsa.ucsf.edu ***************************************************************** Notice to Readers Availability of Food Safety Information for Nursing Home Directors, Food Service Workers, and Persons with AIDS A Food and Drug Administration (FDA)/CDC educational packet on food safety for nursing home directors and food service workers, "Handle with Care" (stock no. PB92-780857), is available from the National Technical Information Service, telephone (800) 553-6847. A public information pamphlet on Salmonella enteritidis is available from CDC's Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Mailstop C-09, 1600 Clifton Road, NE, Atlanta, GA 30333. A CDC/FDA videotape, "Eating Defensively: Food Safety Advice for Persons with AIDS," (see review below) is available from the CDC National AIDS Clearinghouse, telephone (800) 458-5231. (Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, October 22, 1993.) A copy has also been supplied to all VA Medical Center Libraries by AIDS Service, VACO. ***************************************************************** Eating Defensively: Food Safety Advice for Persons with AIDS (Audiovisual Review) Producer: U.S. Food and Drug Administration and Centers for Disease Control Description: 1/2 in. videocassette, 15 min., 1989 Target Audience: Dietitians/Nutritionists, Patient Health Education Coordinators Synopsis: Dr. James W. Curran states in his introduction that persons infected with HIV need to be concerned about food which can transmit bacteria and other viruses capable of causing life-threatening illnesses. Dr. Peter Hawley, Medical Director of the Whitman-Walker Clinic, discusses the following points: (1) people with AIDS are at risk of serious illness and death from food-borne infections; (2) these infections are usually intestinal illnesses resulting from consuming foods which contain harmful microorganisms; (3) any food derived from animals must be considered contaminated; and (4) personal and kitchen hygiene are as important as food preparation. Other individuals provide additional information on: (1) cooking food properly to guard against infection; (2) preparing food for cooking; (3) handling fruits, vegetables and leftover foods; (4) protecting cuts or sores on hands to prevent infection; (5) shopping at the grocery store; (6) ordering food in a restaurant; and (7) preparing for foreign travel. Evaluation: This program was produced to alert people with HIV to the special dangers they face from food-borne illnesses. Two points are emphasized: food-borne infections are associated with raw or undercooked animal-derived foods and food-borne microorganisms can have serious consequences for individuals with HIV infection because of their weakened immune systems. The advice to prevent infection is based on practical, common sense information which can, in fact, be utilized by any individual with a weakened immune system. Availability: National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20850. Telephone: (800) 458-5231. Reviewer Info: Michael Howe, AIDS Information Center, Library Services (142D), VA Medical Center, 4150 Clement Street, San Francisco, CA 94121. Telephone: (415) 221-4810 ext 3305. FTS (700) 470-3305. Internet address: hivinfo@itsa.ucsf.edu ***************************************************************** The Physicians Association for AIDS Care's (PAAC) latest contribution to nutrition education: HIV Disease Nutrition Guidelines: Practical Steps for a Healthier Life This 21-page booklet contains recommendations from nutritionists experienced in HIV care. Topics include: advice on balancing food intake, exercise, and stress management, guidelines on managing side effects, and resource information for obtaining further advice, counseling, and support service. Prepared by PAAC and underwritten and published by Stadtlanders Pharmacy. Community-based organizations and physicians are invited to contact Stadtlander's Pharmacy at 1-800-238-7828 to obtain copies for distribution. Editor's Note See also the AIDS Information Newsletter dated March 27, 1992. Nutrition is the featured topic is this issue.