Coping with the complications of HIV/AIDS

Suggestions are made in this chapter as to which foods should be eaten or avoided for the following symptoms:

• Diarrhoea
• Lack of appetite
• Nausea and vomiting
• Sore mouth or when eating is painful
• Other digestive problems
• Changes in the taste of foods
• Skin problems
• Colds, coughs and influenza
• Fever

A person may have two or more of these conditions at the same time so will need to choose suitable foods carefully. Since people react to foods differently, they will have to select those that work for them. Normal mixed diets can be resumed as soon as the problem is resolved.

DIARRHOEA

When a person passes a watery stool three or more times a day, they have diarrhoea. Diarrhoea is a problem for many people with HIV/AIDS; it leads to loss of water and minerals from the body. This loss is even greater if the person is vomiting. In severe cases, diarrhoea causes dehydration, poor absorption of food, significant weight loss and malnutrition, resulting in weakness and further illness. In young children diarrhoea can quickly become serious and, if not treated, lead to death.

Diarrhoea can have many causes. It may be a symptom of disease or a side-effect of medicines and is often caused by contamination of food because of food hygiene problems. It can be made worse by eating certain foods.

Many people mistakenly believe that with diarrhoea they should stop eating and drinking and take medicines. However, reducing food intake may make the problem more serious. Discuss the use of anti-diarrhoeal medicine with a health worker or doctor. Do not use medicine prescribed for other people.

Diarrhoea is the body's way of removing poisonous materials from the gut. Even though most diarrhoea will cease after a few days, the best action is to drink lots of fluid (or the oral rehydration solution ORS) described in the box on p. 37-38, continue eating and treat any underlying cause, if known, until the diarrhoea ceases.

Most diarrhoea can be treated at home, following the simple instructions below. Seek advice from a health worker if it lasts for more than three days, if fever develops, blood appears in the stool, or if you become very weak.

Prevention is better than cure. Many cases of diarrhoea can be prevented by following the rules of hygiene given in Chapter five.

Do not stop eating when having diarrhoea; drink lots of fluids

General recommendations. Drink more than eight cups of fluid, particularly water, per day. It is also good to take fluid in other forms to replace the salts that have been lost and provide energy. Some suggestions are given below for easily digested foods and drinks that will help to rehydrate the body and provide salts, energy and vitamins.

Recommended foods and drinks. Drink soups, fruit juices diluted with water or an oral rehydration solution.

• Eat soft, mashed, moist foods such as soft vegetables and fruit, porridge from cereals, rice, bananas, potatoes and stews with refined maize meal, rice, barley or potatoes. Soft vegetables also include squash, pumpkins and carrots, and vegetable soup. See recipes in Annex 1.
• To replace lost minerals, eat soft vegetables and fruit, particularly bananas, mangoes, papaya, watermelon, pumpkins, squash, potatoes and carrots.
• Eat refined foods (soluble fibres) such as white rice, maize meals, white bread, noodles and potatoes.
• Peel and cook vegetables and fruit so they can be better tolerated.
• Eat food warm, rather than very hot or very cold.
• Eat small, frequent meals.

Foods and drinks to limit or avoid. Some foods can make diarrhoea worse. Try to remove one food at a time from the diet and see if it makes a difference.

• Fats can make diarrhoea worse and cause nausea. Fat intake should then be reduced, adding less or no cooking oil, cutting off visible fat or skin from meat and boiling food rather than frying it. However, fat is an important energy source and should not be omitted from a diet unless really necessary.
• Green, unripe and acidic vegetables and fruit such as tomatoes, pineapple and citrus fruit sometimes may not be tolerated.
• Milk sometimes may not be tolerated, so see if heated milk or yoghurt is digested better.
• Coffee, tea and alcohol can worsen dehydration. They should be replaced by other fluids such as water, herbal tea and soups.
• Very spicy foods such as chillies and pepper may sometimes make diarrhoea worse.
• Foods such as beans, broccoli, cauliflower, cabbage, Brussels sprouts, onions and green peppers that produce gases should be avoided.

A person should drink as often as possible throughout the day and night and every time a stool is passed. An adult normally needs about 1.5 litres or eight cups of fluid per day. In severe cases of diarrhoea this may be increased to up to three litres a day.

LACK OF APPETITE

Poor appetite is one of the most common problems in people with HIV/AIDS. It can have many causes including infections, pain (particularly in the mouth or gut), depression, anxiety, tiredness or poor nutritional intake. The feeling of hunger may disappear or the person may be easily satisfied and therefore not want to eat enough. However, it is very important to continue eating to prevent weight loss and malnutrition and to maintain strength in order to speed recovery.

When not hungry … the best way to regain appetite is to eat

• Try different foods until you find those that you like and try to have a mixed diet.
• Eat smaller meals more often. Eat whenever your appetite is good - do not be too rigid about fixed times for meals.
• Try the recipes for simple meals in Annex 1 that can help to restore appetite.
• Try to drink a lot of water, milk, yoghurt, soups, herbal teas or juices throughout the day. Drink mainly after, and in between meals - do not drink too much before or during meals. Recipes for herbal teas and spice drinks are given in Annex 1.
• Add flavour to food and make it look and taste interesting. Squeeze some lemon juice over it or add spices such as cardamom, fennel, coriander and cinnamon.
• Avoid fizzy drinks, beer and foods such as cabbage, broccoli and beans that create gas in the stomach and can make you feel bloated.
• Try rinsing your mouth out before eating as this can make food taste fresher.
• Take light exercise such as walking outdoors, for example, and breathing plenty of fresh air to stimulate an appetite.
• Eat in a well-ventilated room away from cooking or unpleasant smells.
• Eat with your family or friends. If you have to stay in bed, they can join you at your bedside.
• Avoid alcohol. It reduces appetite, weakens the body and interferes with medicines.
• If the reason for lack of appetite is diarrhoea, nausea and vomiting, or a sore mouth, follow the guidelines given later in this chapter.

NAUSEA AND VOMITING

Nausea reduces the appetite and can be caused by certain foods, hunger, infections, stress and lack of water. It can also be a side-effect of medicines although certain medicines can help to relieve nausea. A health worker will provide advice.

If vomiting occurs, the body will lose water and will dehydrate even more quickly. If a person is too sick to eat, small and frequent drinks of water, fruit juice and vegetable soups may help (see Annex 1).

How to deal with nausea and vomiting

General recommendations

• Sit up when eating. Try not to lie down until one or two hours after eating.
• Drink plenty of fluids after meals.
• Try not to prepare food yourself. The smell of preparing or cooking food may worsen the feeling of nausea. Ask somebody else to prepare food or eat foods that require little preparation.

Recommended foods to eat and drink

• If vomiting occurs, keep drinking small amounts of water, soups and spice teas (see Annex 1). Eat soft foods and go back to solid foods when the vomiting stops.
• You may be able to relieve the feeling of nausea by smelling fresh orange or lemon peel, or by drinking lemon juice in hot water or a herbal or ginger tea (see Annex 1).
• Eat dry and salty foods such as toast, crackers and cereal.

Foods to avoid

• Fatty, greasy and very sweet foods can make nausea worse. Try to remove one food at a time from the diet to see if it makes a difference. If so, avoid that food. What affects one person may not affect others. People need to find out what suits them best.
• There are medicines that can reduce nausea. Discuss with a doctor or health worker.

SORE MOUTH OR WHEN EATING IS PAINFUL

Soreness of the mouth and tongue is common in people with HIV/AIDS. A sore mouth can make it difficult to eat, thus reducing food intake.

How to deal with a sore mouth

• Eat soft, mashed, smooth or moist foods such as avocados, squash, pumpkins, papaya, bananas, yoghurt, creamed vegetables, soups, pasta dishes and minced food.
• Add liquids to foods or soften dry food by dipping in liquids.
• Drink cold drinks, soups, vegetable and fruit juices.
• Use a straw for drinking fluids.
• If the gums are painful and brushing the teeth is not possible, rinsing the mouth with bicarbonate of soda mixed with water will make the mouth feel fresh.
• Chewing small pieces of green mango, kiwi or green papaya may help to relieve pain and discomfort.
• Drinks such as spice teas, fermented sour cabbage water or yoghurt may help to ease a sore mouth when eating is painful (see Annex 1).

Foods and drinks to avoid

• Very spicy and salty foods such as chillies and curries.
• Acidic or very sour foods such as oranges, lemons, pineapple, vinegar and tomatoes.
• Food and drinks that are too hot or too cold. Keep food and drinks at room temperature.
• Foods that need a lot of chewing such as raw vegetables, or are sticky and hard to swallow such as peanut butter.
• If candida (oral thrush) is diagnosed, cut down on sweet foods such as sugar, honey and sweet fruit and drinks because sugar may make the condition worse.

OTHER DIGESTIVE PROBLEMS

People with HIV/AIDS may have problems in digesting certain foods or may suffer from constipation and bloating. These problems are caused by damage to the naturally occurring bacteria in the intestine, which are needed to digest food. These bacteria may be destroyed by antibiotics or other medicines.

How to deal with these problems

General recommendations

• Chewing food well will make it easier to digest.
• Chopped papaya added to meat acts as a tenderizer and helps digestion.
• Fermented foods such as sour cabbage water, sour porridge, yoghurt and sprouts (see Annex 1) can be easier to digest and help the digestion of other foods.
• Use recommended foods as if they were medicine, particularly during and after antibiotic treatment. Eat three times a day before or with meals and continue for two weeks.

Foods to avoid

• People can experiment by omitting a particular food and seeing if it makes them feel better. Some people find fatty foods such as fried foods, chips, hard cheese, peanut butter and cream difficult to digest. However, they can go back to a normal mixed diet once they feel better.

How to stop constipation

• Eat insoluble fibre, contained in foods such as raw vegetables and fruit, dried fruit, wholemeal dark bread, whole-grain cereals, nuts and seeds.
• Eat frequent and small meals regularly throughout the day.
• Drink plenty of fluids throughout the day.
• Be active and exercise regularly to stimulate bowel movement and improve digestion.

How to prevent a bloated feeling

• Do not drink too much with food.
• Avoid foods such as cabbage, beans, onion, broccoli, Brussels sprouts and cauliflower and cold fizzy drinks that create gas in the stomach.
• Some people find it difficult to digest wholemeal foods and foods rich in dietary fibre, particularly when the diet also contains sugar and sugary foods. Try to exclude sugar and sugary foods from the diet for a while.

CHANGES IN THE TASTE OF FOODS

As a result of drug side-effects and infections, people may find that foods have a different taste or texture from usual. They may develop cravings for food that they did not like in the past. However, these situations are common during illness.

How to deal with these changes

• Experiment with different foods and spices until you find foods you like. Try to have a varied diet.
• Mint, garlic, ginger and other herbs and spices may seem to lose their taste when medicines are being taken. Try preparing food with sugar, vinegar or lemon instead.

SKIN PROBLEMS

Skin problems such as rashes and sores are common in people suffering from HIV/AIDS. Other problems such as dry patches or poor healing of wounds may be related to malnutrition or specific micronutrient deficiencies.

Poor skin conditions can be caused by lack of vitamin A or vitamin B6. Although many skin problems may need specific medical treatment, the addition of foods rich in vitamin A and/or B6 to the diet may help to prevent skin problems or improve the condition over time. Good sources of vitamin A are yellow, orange and green vegetables and liver. Good sources of vitamin B6 are cereals, kernels, whole grains, seeds and nuts as well as figs and green leafy vegetables.

COLDS, COUGHS AND INFLUENZA

Colds and influenza (flu) are common virus infections that can cause a runny nose, sore throat, cough and sometimes fever. However, these infections almost always disappear without medicine.

How to deal with colds and flu

• Drink plenty of water or other fluids and have plenty of rest.
• Prepare special teas for colds (see Annex 1) and drink them for as long as symptoms last.

A cold normally lasts about a week. If it lasts longer, or other symptoms are present such as a high fever or a cough with a lot of mucus, blood or odorous discharge, see a health worker because there may be an underlying infection.

Coughs

Coughing is how the body cleans the lungs and throat by getting rid of mucus and germs. Therefore, do not take any medicines to stop coughing but try to loosen the mucus.

• Breathe in hot vapours. Take a bowl or pot filled with very hot water and cover the head with a towel. Breathe in the vapours deeply for ten minutes, twice a day. Eucalyptus, mint or thyme leaves can be added, but hot water works just as well on its own.
• Try onion tea or cough syrup to ease the symptoms (see Annex 1).
• Drink lots of water or other fluids.

Sore throat

A sore throat is usually caused by colds or flu and is normally not serious. However, if it persists for several weeks, see a health worker. The following may help to ease a sore throat.

• Crush a lemon and mix it with honey. Take a large spoonful as necessary.
• Try gargling a strong solution of salt and water several times a day.
• Prepare teas and plant extracts for sore throats (see Annex 1) and take them for as long as the symptoms last.

FEVER

• Drink plenty of fluids.
• Cool down by sponging your body with a wet cloth.
• Try traditional remedies for reducing fever, such as neem tea (see Annex 1). Aspirin or paracetamol can also be taken but read the instructions carefully about safe doses first - especially when giving to children.
• Do not give aspirin to children or people with stomach and kidney problems.