Building a High Quality Diet

By Margo Woods, DSc, Emily Potts, MSc, and Joan Connors, DMin, RD

What is a high quality diet?

A high quality diet is a diet high in vegetables, fruits, whole grains, and legumes, with lean, low-fat protein sources. These foods are nutrient-dense, and will contribute much more to your health and well-being than empty calories from sugar and fat.

Tips for a building a high quality diet:

• Eat 5–6 servings of fruits and vegetables per day, or approximately 3 cups. Eat a variety of colors for a full range of nutrients.
  
  
• Aim to have 50% of your carbohydrates come from whole grains.
  
  
• Choose lean protein sources such as skinless chicken breast, fish, extra-lean cuts of pork and beef, and low-fat dairy products.
  
  
• Limit added sugar, sweets, and soft drinks; they are low in nutrient density and cause spikes in glucose levels.
  
  
• Have a serving or more of nuts, seeds, or legumes per day.
  
  
• Whether eating a full meal or snacking, include all 3 macronutrients: protein, carbohydrates, and a little fat.

See “Choose snacks that work for you.”

Protein

Proteins are the building blocks of your muscles, organs, and many of the substances that make up your body’s immune system. When you don’t supply enough calories and protein through food, your body uses its own protein (muscles) to make up for the lack of fuel. This results in the weakening of your body and immune system.

The Recommended Daily Allowance (RDA) for protein is 0.4–0.5 grams per pound (0.8–1.0g/kg) of body weight for a healthy adult. For a 160 lb healthy male, that would be 64–80 grams of protein per day. More protein may be required to maintain or build lean body mass in a person with HIV, from 0.6–0.9 g/lb (1.2–2.0g/kg) of body weight. An approximate rule of thumb is 100–150 g/day in HIV+ men and 80–100 g/day for HIV+ women. Protein intake should not be greater than about 15–20% of total calories; extremely high protein diets can stress the kidneys.

Lean meat, poultry without skin, and fish are good sources of protein; a portion size of 3–4 ounces is about the size of a deck of cards. Eggs and low-fat dairy products are also good. In addition to these animal sources, you can also get protein from legumes (dried beans and peas), nuts, and seeds. Vegetables and grain products such as wheat bread, pasta, barley, and rice contain minimal amounts of protein.

See “Protein and fat content of selected foods.”

Carbohydrates

Carbohydrates give you energy. A healthful diet is high in complex carbohydrates (whole grains, whole grain products, and legumes) and low in simple carbohydrates (sugar, candy, soft drinks, cakes, cookies, ice cream). Within the category of complex carbohydrates, legumes and whole grains such as whole wheat flour, oats, barley, and brown rice, are better sources of carbohydrate than white bread and pasta, rice, and potato. They are higher in nutrient values and fiber and are absorbed by the body more slowly to provide a steady source of glucose, better sustaining you until the next meal. These foods may also be helpful for people with diabetes or insulin resistance.

See “Fiber content of selected foods.”
See “Lipodystrophy.”

Fats

Fat is the body’s major source of energy storage. The recommended intake of total fat is less than 30% (25% preferred) of daily total calorie intake, but the kind of fat may be as important as the amount. Saturated fat increases the risk of cardiovascular disease (CVD). People with HIV may experience medication-related high cholesterol and triglycerides, requiring caution with regard to CVD. Omega-3 fatty acids (a type of polyunsaturated fat), found in heart-healthy fish and other foods, are protective against CVD.

Saturated Fat:
Recommendation: 7% or less of total calorie intake
Food sources: fatty meat, poultry with skin, butter, whole-milk dairy foods, and coconut and palm oils

Monounsaturated Fat:
Recommendation: 10% or greater of total calorie intake
Food sources: nuts, seeds, canola and olive oils, avocado, and fish

Polyunsaturated Fat
Recommendation: 10% or less of total calorie intake
Food sources: fish, walnuts, flax seed & oil, and corn, soybean, sunflower, and safflower oil

See “Omega-3 fatty acid content of selected foods.”

How many calories do I need?

Calories are the energy in food. They provide your body with the fuel it needs to keep running. If you are HIV-positive, you will need to increase the amount of food you eat to maintain your lean body mass. You need at least 17–20 calories per pound of body weight. During infections and fever, however, your calorie needs may be higher than usual.

• If your weight is stable and there is no opportunistic infection, use 17–20 calories/lb.
  • Example: If you weigh 140 lbs., you may need 2,380 calories per day (using 17 calories/lb.).
    
• If you have an opportunistic infection, use 20 calories/lb.
  • Example: If you weigh 140 lbs., you may need 2800 calories per day.
    
• If you are losing weight, use 25 calories/lb.
  • Example: If you weigh 140 lbs. and have lost 10 lbs. in the last 6 months, you may need 3,500 calories per day.

Keep in mind that calories from healthy, nutrient-dense foods will keep you healthier than empty calories from sugar and fat.

Putting It All Together

General dietary guidelines recommend a daily intake of:

• 15-20% Protein
  
• 50-60% Carbohydrate
  
• 25% Fat
  

Now that you have an idea of how many calories you may need each day, and how to make good choices with proteins, carbohydrates, and fats, see “Dietary Guidelines: A Breakdown by Calorie Intake” for examples of how many grams per day of each of the three groups add up to your daily calorie needs.

Nutrition Supplements

If you are losing weight and do not have adequate food resources, talk to your doctor about adding a nutrition supplement, such as Carnation Instant Breakfast, Boost, or Ensure. Whenever possible, we believe the best way to increase weight is to eat a high quality diet that is nutrient-dense.

See “Weight Loss/Wasting.”

We know that most people with HIV do not always eat 100% of the Recommended Daily Allowance (RDA) of all nutrients. For this reason, we recommend taking one or two multivitamin/mineral tablets (without extra iron) providing at least 100% of the RDA (check label) per day. Always discuss any supplement use with your doctor.

For more information about vitamins, minerals, and supplements, including roles in the body, RDAs, upper safety limits, and best food sources, visit the National Institute of Health’s Office of Dietary Supplements site.
http://dietary-supplements.info.nih.gov/showpage.aspx?pageid=89