HIV 101














"Cherry Picking Best Nutrition Practices"

By: Alan Lee, RD, CDE

Let's face it, on some level (thank goodness) living with HIV is not a barrier to living the best life possible. In my intergenerational HIV practice, newly diagnosed patients are as diverse as America itself. From men who have sex with men who are under the age of 45 to those who identify as transgender women or transgender males, I can give these newly diagnosed people hope that they can expect to live a satisfying health/life span. We often target our sessions to focus on what I can do for them in a world where nutrition advice is simply a click away.

The Internet has brought a wide range of nutrition “information” from many sources. There are over a dozen fad & weight loss diet plans that have been noteworthy to take a closer look at. My patients ask questions about the latest diet fads as well as the “classic” trends that come back every decade. From the Atkins Diet, to the Gluten-Free Diet, and Weight Watchers in between.... which ones really work for weight loss and overall good health? Some are diets that we forget, some are tried and true, and some are dangerous....

Fad diets usually persist over time because there are some elements of truth to them. People often see results when adopting a new food plan especially when it reinforces your mindful attention to improve your health. In the beginning of a new approach to eating, the food choices can be intriguing and the change in routine is fun. But fad diets when followed literally for long periods of time are almost always unsustainable and can be detrimental for long term health for persons living with HIV. However, some aspects of fad diets “come back” in new forms and are sometimes reasonable to consider. Obviously, you will want to consult with a Registered Dietitian (RD) for customized nutrition advice to see what might work for you in the short-term as well as in the long-term.

Cherry Pick These Elixirs of Nutrition Truth
I suggest that you work with your RD to “cherry pick” from the wide range of available diet and nutrition information based on your own knowledge of what will motivate you to pay closer attention to the amount and types of food that you eat. There are no junk foods, just junk eating patterns. Here are some general tips based on some of the widespread diet plans:


This popular diet restricts carbohydrates to attempt to change the body’s metabolism by putting your body into a ketogenic state where you start using ketones produced from fat in the liver for brain fuel and energy. The cons include a high saturated fat content and very limited fiber. It is also difficult to stick with. But the “cherry pick” point is a reduction in refined carbohydrates – rather than eliminate all bread, sugar and carbs, plan to reduce those foods and substitute more whole grains. You should talk to your primary care provider before starting any version of this diet.


This eating plan has become popular in recent years, although gluten-intolerance is actually quite rare. The cons are that you need to eliminate healthy whole-grains like rye and barley which naturally contain the protein gluten. And many foods contain at least small amounts of gluten like soy sauce and beer. “Gluten-free” products and gluten-free versions of wheat pasta and egg noodles are significantly more expensive than their conventional counterparts. But the “cherry pick” points are that many “gluten-free” foods are natural, whole foods like fresh vegetables and that there are many unusual grains that have interesting tastes and more protein than refined wheat, such as rolled oats and quinoa.


This eating plan became popular in the 1990s based on research into the lifespan and diets of Mediterranean natives. The cons are that many people do not find that sticking 100 percent to this approach fits their cultural upbringings. But the “cherry pick” points are to focus mainly on plant-based foods, eating seafood and fish at least twice a week, and heart-healthy olive oil.


This eating plan is based on the idea of eating like our prehistoric ancestors. It’s an interesting idea, although life expectancy for cavemen was probably 20 – 35 years. The cons are missing out on all the foods invented in the past 40,000 years. Personally, absolute abstinence from mint chocolate chip ice cream might be too much of a sacrifice! But the “cherry pick” point is a focus on nuts, seeds, and cooking meals from scratch.


This eating plan takes the approach that you will feel “satiety” (the feeling of being “full” and satisfied) with three small meals and two snacks every day with no more than five hours between them. The cons are that you may find it difficult to strictly adhere to 40% carbs, 30% protein and 30% fat macronutrient ratios at every meal. But the “cherry pick” point is never letting more than 5 hours go by without eating and less saturated fat consumption than the Atkins Diet.


This eating plan has been around since 1963 and has evolved over the years. The current version of the program focuses on counting SmartPoint values that are assigned to different foods based on protein, added sugars, and saturated fats. It really is an evidenced based lifestyle change program with long-term success behind it. The cons are the comprehensive on-line and in-person meeting group costs can be expensive to have access to indefinitely. But the “cherry pick” point is a mindful approach to portion control and a wide range of available packaged foods that are clearly marked with their “point” value so you know you can make good choices on the go. (Here’s an RD secret: the range for one point is 40-60 calories per point. And in general, if you are allotted 30 points per day then it is probable you have been prescribed a 1200-1800 calorie per day eating plan.)

Your immune system is working on overdrive to stave off persistent inflammation but with healthy food working in tandem with combination antiretroviral medications, you have the upper hand on HIV. Recharging your vigilance for healthy eating and introducing new foods can help you develop an improved approach to your eating patterns. If you are reading this article, then you are interested in keeping up with nutrition science that will continually advance. Ultimately, the best eating plan is the one that you will stick with for the long term – and if that plan is actually a constantly evolving diet of the “greatest hits” of the nutritionally sound elements of popular and new plans, then you are cherry-picking your way to health. As you learn about new nutrition information, consult with your RD to put the best elements to work for you that are pleasurable and practical.

About the author:

Alan Lee, RD, CDE, CDN, CFT has over 20 years of experience as a nutritionist for people living with chronic diseases such as HIV, hepatitis C, and diabetes. He works as a primary care dietitian at the Apicha Community Health Center & the Family Health Center Of Harlem. He is also a nutrition consultant for the Einstein College Of Medicine in the Hepatitis C Program, TOUCH, Inc. in Rockland County, NY, and SAGE-USA in New York, NY. He maintains a private practice based in NYC and is a recognized speaker on nutrition and HIV. For the last six years, he has been a special guest speaker at Teacherís College at Columbia University for their graduate level Medical Nutrition Therapy course on HIV nutrition. He can be reached at (212) 229-2298 and AlanLeeRD@yahoo.com. .  




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