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Siyayinqoba Beat It! 2005 Episode 26 -

Nutritional supplements for people living with HIV

In this episode we spoke about why vitamins and micronutrients are necessary and how much we should take to maintain a balanced diet. To help us discuss these issues, we were joined by Irene Labuschagne from the University of Stellenbosch who works with people living with HIV. Jason ended the show with a few helpful tips on positive living.

Jason Wessenaar: Hello and welcome to the Siyayinqoba Beat It! Support Group. My name is Jason. In the Siyayinqoba Support Group we are all living positively with HIV. Each week we get together to talk about issues that affect our lives with HIV from gender-based violence to healthy eating for the positive person. Siyayinqoba is your guide to better living with HIV. If you are living with HIV or have a partner, a family member or a friend who is HIV positive, Siyayinqoba is for you. We hear a lot about micronutrients and vitamins in the news and newspapers and how good they all are but what do people living with HIV really need. This week we are talking about why vitamins and micronutrients are necessary and how much we should take to maintain a balanced nutrition. To help us discuss these issues, we are joined by Irene Labuschagne from the University of Stellenbosch who works with people living with HIV, welcome Irene. We also welcome Bulelwa who’s our youth guest today, welcome Bulelwa. But first let’s see what the Beat It! team found out when we accompanied Busi and Ricardo during their visit at Tygerberg Hospital to find out what micronutrients and vitamins they need in their diet to support their immune system and keep them healthy.

What is good and what is bad for you?

Cape Town, Western Cape

Busisiwe Maqungo: Why is it important for me as a person living with HIV, to have good nutrition?

Roy Kennedy (Registered Dietician, Stellenbosch University): HIV is an infection and as with any other infection, measles, TB, it increases the need for nutrients in your body because it has an effect on the body that creates fever, inflammation and all of this creates increased requirements for different nutrients. And at the same time HIV creates as the disease progresses a number of symptoms such as nausea, vomiting, sore mouth, which makes it difficult for people to eat and in the light of that it becomes maybe more important to look at how we can support the intake of food and nutrients which may even require supplements at some stage.

Busisiwe Maqungo: You comment taking of the supplements as a person living with HIV but I’m just wondering, can’t I get the same nutrients that I’m supposed to be getting from the supplements just by eating ordinary food?

Roy Kennedy: Under normal conditions we would say that you can probably get all the micronutrients, the minerals and the vitamins that you require from taking about five portions of different fruits and vegetables in a given day. However, we now have enough evidence from research that was done in HIV that the inflammation creates an increased requirement above that of people who are not infected. And from that evidence we now have, we may recommend a general multivitamin supplement.

Busisiwe Maqungo: Can supplements really replace the need for ARVs?

Roy Kennedy: As nutritionists, our point of view is that antiretrovirals are an important aspect of the management of HIV infection and we do not at all promote the use of vitamin supplements as a replacement for antiretrovirals. However in the light of what we’ve now spoken about the increase requirements for nutrients, we do advise multivitamin supplements as an addition to antiretrovirals.

Ricardo Moses: Ek was verwys hiereen weens gewig verloor en omdat ek MIV positief is. Is daar enige advies wat jy miskien vir my kan gee? {Afrikaans} [I was referred here because I’m HIV positive and losing weight. Can you give me any advice?]

Roy Kennedy: Wat die virus doen is om jou metabolisme te verander sodat jy eintlik van jou protein stourre of jou spier massa eintlik begin opgebruik vir energy en dit raak dan moelik om dit teen te veg met net die diet alleen. Ons bevel an dat mense genoeg moet eet natuurlik om genoeh energie en proteine in te kry maar dit help ook om meer aktief te wees; om die spiere te gebruik en sodoende die spier massa te onderskraag. {Afrikaans} [The virus changes your metabolism so that you use your protein store or muscle mass for energy. This is difficult to counter with diet alone. We do recommend that you eat well for energy but it also helps to be more active, to use the muscle and build up the muscle mass.]

Ricardo Moses: Ek is ’n rooker en watter nadele hou die rook vir my in met die gewig verloor? {Afrikaans} [I’m a smoker. What are the disadvantages of smoking in regard to weight loss?]

Roy Kennedy: Ja jy het nou begin om te sê jy sulke met jou gewig en die rook kan nogal daarby by dra want ons weet dat rook die eetlus onderdruk en dan het die rook ook ’n effek op jou behoeftes van seker vitamiene; ons weet dat vitamien C wat een van die anti-oxidante is die behoefte daaraan verhoeg as mense wel rook. {Afrikaans} [You mentioned your weight loss, smoking contributes to that. We know that smoking suppresses appetite. Smoking also affects your need for certain vitamins. Your need for Vitamin C, one of the anti-oxidant vitamins increases when you smoke.]

Ricardo Moses: So nou en dan neem ek ook so ’n bietjie alcohol, is dit voordelig of nadeelig vir my ook weens die gewig verlees? {Afrikaans} [I drink occasionally, is it beneficial or harmful in regard to weight loss?]

Roy Kennedy: Alcohol wat mens in drank kry verskaf eintlik energy so dit behoort nie ’n probleem te wees met die gewig verlees per se nie maar as mens ’n klein bietjie alcohol gebruik dan sal jy eintlik vind dat jou eetlus, jy sal dit dalk al self gevind het, dat jou eetlus sal eintlik ’n bietjie verbeter. Maar as jy ’n bietjie meer alcohol gebruik dan onderdruk dit weer jou eetlus en mens wil nie hê dat die alcohol ’n plaas verwanger word dan vir die kos eintlik nie. {Afrikaans} [Alcoholic drinks give you energy and as such should not contribute to losing weight. If you take alcohol in small amounts, you’ll find that your appetite improves. But if you take more alcohol, your appetite is suppressed. And we don’t want alcohol to become a substitute for food.]

Ricardo Moses: Dan wat ek ook graag wil weet is: ek het gehoor mense praat van zink. Is dit voordeelig of nadeelig? Kan jy dalk vir my miskien dalk ’n bietjie meer inlig rondom dit? {Afrikaans} [I’ve heard people talk about zinc, is zinc beneficial or harmful? Can you tell me more?]

Roy Kennedy: Die nuutste inligting wat ons het rondom zink en die supplementeering van zink is dat mens ’n bietjie versigtig is met die zink. Daar is navorsing wat vir ons wys dat die virus eintlik floreer met ’n groot hoeveelheid zink in die ligaam en daarom bevel ons nie aan dat mense individuele supplemente gebruik van individuele nutriente nie maar om eerder dit te neem as deel van ’n multi-vitamien, multi-mineral supplement. {Afrikaans} [Based on the latest information, one has to be careful with zinc. Data shows that the virus flourishes amidst high zinc levels in the body. Hence we don’t recommend people to use individual supplements of nutritional elements but as part of a multi-vitamin, multi-mineral supplement.]

Support Group

Jason Wessenaar: Irene what are vitamins and micronutrients and why do you need them?

Irene Labuschagne (Registered Dietician, Stellenbosch University): Basically micronutrients are organic substances but you need them in very small amounts in comparison to energy and the macronutrients. And basically we can’t cope without them and we need them to live but also to be healthy in general terms.

Anthony Fernandes: What is the most clear thing to take other than just saying multivitamin because there could be hundreds of homeopathic multivitamins and things which have added minerals and vitamins in them as well.

Irene Labuschagne: Normally I try and educate the public by saying if you turn it around and look at the composition, the recommended daily allowances, the percentage of the RDA in other words and then you find that a product is rated as good if the percentages of the RDA is not excessive. If it’s between 100 and 200% of the RDA of all the listed ingredients, it’s a balanced good product. But it’s important to know where to get the correct advice and if we’re talking about micronutrients or vitamins and minerals or supplements, then the great place to get that advice would be maybe your doctor, a qualified practitioner or then a dietician and if none of those are available, you can also ask your clinic sister. The best approach again, if you want to buy micronutrients or vitamins and minerals, to ask for a product that only contains vitamins and minerals and nothing else.

Lihle Dlamini: It means that if I get multi-vitamins from my local clinic, that will be fine.

Irene Labuschagne: If your local clinic gives out multivitamins, they normally give out B complex and we know that’s fine, it’s actually good to take.

Jason Wessenaar: Irene, which vitamins are important to slow down the progression of HIV from HIV to AIDS? And also which vitamins are important to take once you’re on the AIDS stage so that you can get better?

Irene Labuschagne: The studies use different preparations but once that has been identified to be really beneficial is the B vitamin, we’ve mentioned them, vitamin C, vitamin E. So those are the major ones that have shown real benefits in delaying the progression of the disease. Vitamin A showed no real effect, not on the progression and ideally it should not be included in the preparations or the multivitamins. If you are ill and have AIDS, it depends on what your symptoms are, some people just have anorexia in the terms that they don’t have any appetite, they don’t want to eat, so the problem there is that we need to add to that diet to ensure that they get all the nutrients they need, that’s an example. And then again a multivitamin would be of great help or a supplement, a meal in a glass supplement with added vitamins and minerals might be an option. So choose your routes wisely, go for one or the other or alternate between these different options but don’t do everything and think that more is better because it’s not necessarily better.

Jason Wessenaar: We’ll talk more about vitamins and micronutrients after the break.

Jason Wessenaar: {Sesotho} Welcome back to the Siyayinqoba Support Group – the programme for everyone infected and affected by HIV. Can vitamins and micronutrients reverse AIDS to living healthy with HIV as some have claimed? To get a better understanding of the role of vitamins and micronutrients, the Beat It! team spoke to Prof. Demetre Labadarios.

Can nutrients reverse the course of AIDS?

Stellenbosch, Western Cape

Prof. Demetre Labadarios (Stellenbosch University): Well, the ones that you hear a lot about are micronutrients, in other words we need them in small amounts on a daily basis and they are essential nutrients. And usually we collectively call them vitamins and minerals. However any disease affects our bodies not only in specific nutrients but in general terms as well. And such in relation to body weight management, one of the critical nutrients that is not talked about is energy. Energy intake is incredibly important in any type of disease, especially HIV/AIDS.

Dr Eric Hefer: Belangrikke elemente wat pasiente na moet kyk is watter supplementasie hulle wat want dit is aanvaar dat HIV pasiente gaan supplementasie nodig hê – daar is nie ’n debaat daaroor nie. Maar dit is net dat hulle moet weet wat hulle gebruik want dit het sekere, dit het beslus ’n betekenisvolle invloed op hulle siekte proses en ook die ander medikasie wat hulle gebruik. {Afrikaans} [It’s important for patients to look at what supplements they use. It is accepted that HIV positive patients will need supplements. They must know what they are using because it has significant impact on their disease process and on the other medication they take.]

Prof. Demetre Labadarios: My advice would be, if you want to take a supplement, ask your doctor or ask a dietician regarding the dose that you must have and most of all do not exceed what your doctor recommends. Because we always have these difficult situations, that a little bit of something is good, which it is, and then we make the assumption; a little bit more will be better, well it’s not, it can actually be dangerous. And most of all they need to remember that no single nutrient, in any way, on it’s own, can actually alter the course of any disease, any disease especially HIV/AIDS.

Dr Eric Hefer: Hypoxis of African potato is goed nagevors en die navorsing is hier in Suid Afrika gedoen by Stellenbosch Universiteit. Dit is wel bekend dat dit gebruik word deur studente wat MIV het en dat dit baie voordele in hou. Die probleem wat ons wel daarmee het is dat dit in samewerking met antiretrovirale middles het ons ’n probleem met interaksie. Die hypoxis beinvloed die absorbsie en die metabolisme van die antiretrovirale middele. So dit beteken hierdie middels dus nou nie meer effektief genoeg is nie en as die dokter nie weet dat jy die hypoxis ook neem saam met jou antiretrovirale middels dank an hy nie aanpassings maak daarvoor nie. So die beste is dat ’n pasient aan hulle vertel watter ander supplementasie hulle neem sodat hulle vir hulle kan adverseer wat is die regte manneer om die middels te neem of om watter middels uit te sny en te vermy. {Afrikaans} [Hypoxis or the African potato has been well researched. The research was done here at Stellenbosch University. It’s well known that HIV positive patients use it and that it holds many benefits. The problem is that, taken with antiretroviral medication, we have a problem with interaction. The hypoxis affects the absorption and metabolism of the ARVs. It causes the ARVs to be less effective and if your doctor doesn’t know you’re taking hypoxis with your ARVs, she/he can’t make adjustment for it. It’s best to tell your doctor what supplements you are taking so that your doctor may advise you of the best way to take supplements or on which things to avoid or omit.]

Prof. Demetre Labadarios: Evidence that has been confirmed is that if you eat too much garlic, it lowers the levels in the blood of certain ARVs which actually makes the treatment of ARVs ineffective.

Dr Eric Hefer: Bly weg van voofies, bly weg van middels wat klame maak dat hulle fantastiese resultate toen. In dien daar enige werklike wetenskaplike was wat dit gedoen het dan sou ons hulle al lank al gebruik het. So wees versugtig; daar is bety mense ddar buite wat gewentenloos teer op mense omdat hulle weet dat HIV pasiente partykeer desperaat is en in die nood is en dus baie vatbaar is vir van hierdie reklaame veldtogte en onwetenskaplike kombinasies wat die wêreld belowe en op die ou ende net tot die pasient se nadeel strek. {Afrikaans} [Avoid false cures, avoid products that claim to show fantastic results. If there were real scientific products capable of such results, we would have been using them. Be careful, there are unscrupulous people who prey on others because they know people with HIV are sometimes desperate, in dire need and vulnerable to those marketing campaigns and these unscientific compounds that promise the world but eventually only harm the patient.]

Support Group

Jason Wessenaar: What’s important, eating in quality or in quantity?

Irene Labuschagne: It’s important to eat in quality but also in quantity at times. It’s really important to realise that being HIV positive, you have increased need. The infection robs our body of some of the vitamins and minerals we’re talking about and it makes our bodies utilise that at a much higher rate than someone who doesn’t have HIV/AIDS. And that’s why it’s such a great help if you can afford to supplement, but I can’t emphasize enough how important fruit and veg is in this diet. They are the primary providers of your vitamins, minerals and antioxidants.

Jason Wessenaar: What is likely to happen to somebody who’s living with HIV if they don’t eat fruit or they don’t take supplements at all? Secondly, what are antioxidants?

Irene Labuschagne: Can I start with the second question, it’s easier that way around. Antioxidants are basically nutrients that protect our cells from damage because we have damage coming from all different directions. We’ve got pollution, we’ve got harmful substances that we eat and we’ve got viruses et cetera and these antioxidants are basically, we all know Vitamin C, it’s one of the best known antioxidant. With fruit and vegetables mainly in HIV, research has shown that when you take antioxidants, you eat an optimum diet, it sort of delays the time before you get really ill with AIDS and that’s the important factor here. It increases our nutritional status, in other words, how well we are fed, in terms of micronutrients, your energy, your carbohydrates and that but also vitamins and minerals. And to have that at optimum levels is very important to prevent us from getting AIDS.

Busisiwe Maqungo: We get protein from meat and I believe that I need to eat meat everyday so as to replace my muscles that are being destroyed by HIV because HIV also needs to feed and the only thing that I think it eats in my body is muscles, it destroys my muscles, my little body mass.

Irene Labuschagne: You are correct but still you don’t need a lot of meat, you need a moderate portion of meat. A moderate portion of meat would be the size of your hand palm, that’s enough meat in a particular meal. And remember protein also comes from other fruits in our diet, things like soya, dried beans and all the legumes, eggs, milk. So yes those are also sources of good protein but it’s not necessary to eat large amounts of meat to preserve lean body mass.

Bulelwa Cima: Kukho i-confusion eye ndiyifumane elokishini, kuthiwe kufanele thina bantu ba-positive singasebenzisi inyama ebomvu because ithatha i-four hours ukuze ibe-right for igazi lethu. Ngoku nda-decida ke mna uba ngcono ndingayityi ke mna inyama ebomvu because andinayo imali yoves’ke ndihambe emini ndiyothenga inyama, nditye inyama emini and okwesibini kuthiwe ayikho-right inyama enamafutha anqumayo for thina bantu ba-positive. {IsiXhosa} [There is confusion in the townships that HIV positive people should not eat red meat because it takes four hours to metabolise into the bloodstream. So I decided to stop eating red meat because I don’t always have money to buy meat during the day, and secondly they say red meat that has too much fat is not good for HIV positive people.]

Irene Labuschagne: If you like red meat and it doesn’t make you feel uncomfortable, then there is no need not to eat it, eat it in smaller portions. You’re right about the fat in meat, it’s not very healthy to eat a lot of animal fat because it’s not the healthiest type of fat you get. It’s healthier to eat different types of fat, for instance, fat from sunflower oil or fat from nuts, fats from dairy products, to have a variety of fat also in your diet. If you eat fatty meats all the time, you get lots of saturated fat which is not good for your overall health and for your heart health.

Jason Wessenaar: We’ll be right back after this short break. Don’t go away.

Jason Wessenaar: Welcome back to Siyayinqoba Beat It! Support Group, we’re with Irene Labuschagne talking about immune boosters.

Lihle Dlamini: My concern is there are many people who start on antiretroviral roll out in the public sector and many of them use immune boosters as well as traditional medicines, what are the dangers of mixing the traditional medicine or immune boosters with ARVs?

Irene Labuschagne: The main problem would be the interaction between the immune boosters or the traditional medicine, even food like high amounts of garlic, and the action of the antiretroviral drug. If you take immune boosters with antiretroviral drugs, it could actually decrease the efficacy of the ARVs and we don’t want that. If you go on to ARVs, we want the full potential working out of that medication to make you better. And if you are on antiretroviral therapy, I would really recommend that you don’t take any large amounts of garlic because it will decrease the amounts of enzymes available to metabolise the medication and it will decrease the efficacy of your medication, it’s important to know. The African extracts, we also don’t recommend at all. There’s not any research to show that it can actually be beneficial to anyone with HIV. On the other hand there are some small research studies available that show that it can be toxic and that’s a red light and we don’t want to encourage people to take that until we have the results that say it’s safe to take.

Jason Wessenaar: It’s recommended, generally, that people living with HIV should use selenium zinc and Vitamin C, what are the benefits, thereof, if there are any and what are the disadvantages?

Irene Labuschagne: The main selling point for things like zinc, Vitamin C and selenium is because they are powerful antioxidants and we’ve discussed those but what we don’t know is what is the recommended amount if higher than the RDA for things like selenium zinc on it’s own and that’s why the research has focused mainly on giving them in a combination because they interact with one another as well. And taking anything on it’s own might not have the same effect and we don’t have the studies that really show that long term intake of five times the RDA of selenium on its own will have the effect that the multivitamins have so far. And we need to stick with what we have.

Jason Wessenaar: We’re getting a lot of information from you right now, which otherwise we would not have the chance to get anywhere else, what are you doing to address that problem because we don’t have dieticians in public hospitals, really?

Irene Labuschagne: That’s not quite true, there are dieticians in public hospitals, the problem is that the public doesn’t always insist on wanting to see a dietician. Nutrition is a very important part of HIV, it’s a very controversial issue in HIV in nutrition in South Africa. But to want to see a dietician is your right and you can enquire at the public health centre where you are, you want to make an appointment and see the dietician, it’s like a responsibility. As I have mentioned before, I’m from the Nutrition Information Centre and we’re a free information centre and service to the public. We might give the telephone number at the end of the show and anyone who wants to ask a question can phone and ask that question as well. And we’re also trying to reach a lot of people with radio talks et cetera but I know there’s a big need for that and hopefully that will improve and people will get the right information regarding nutrition and HIV and the importance of nutrition and HIV because it’s one of the main lines of therapy as in all other diseases of lifestyle. For instance, diabetes, nutrition is one of the most important therapies in diabetic patients. It should be the same in HIV but it should never replace other important therapies in HIV like for instance ARVs. There shouldn’t be competition between the two lines of therapies they should be working alongside each other to reach healthy people living with HIV.

Jason Wessenaar: Thanks to Irene, Bulelwa, the support group and the viewers at home. Namuhla sifunda ukuthi abantu abaphila ne-HIV kufanele batye izintlobontlobo zokudla. I-HIV idla ama-vitamins nama-nutrients emzimbheni. Singakubuyisela lokho ngokudla kunye nama-supplements. Kubonwa kakuhle ukusebenzisa ama-multivitamins tablets njalo nje kodwa ama-multivitamins kanye nanoma yiphi ama-supplements ngekhe avimbe ukuthi ufike ezingeni le-AIDS okanye aphephe i-HIV. Sifunde ukuthi uma sithatha ama-ARVs kubenesixhumano nomsebenzi wezempilo noma i-dietician ngoba amanye ama-supplements nokunye ukudla kungavimbela ama-ARVs ekusebenzeni ngendlela eyiyo. Sithemba ukuthi nilujabulele uhlelo lwethu lwanamhlanje. Yiba nathi futhi evikini elizayo kwi-Siyayinqoba Beat It! Support Group. {IsiZulu} [Today we have learned that people living with HIV should eat different types of food. HIV uses the vitamins and micronutrients in the body. We can replace that with healthy food and supplements. It is a good idea to use multivitamins once in a while, but multivitamins or nay supplements cannot stop the HIV fro, progressing to the AIDS or cure HIV/AIDS. We have learned that if you are taking ARVs, you should consult a health care worker or a dietician because some of the supplements or food can prevent ARVs from working effectively. We hope you have enjoyed the show and are feeling the Siyayinqoba spirit, that together we can beat it. Join us again next week on the Siyayinqoba Beat It! Support Group. Till then stay well.]

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