The Nutritional Balancing Act

Infection with HIV, like other infections, changes how the body needs, uses, and loses nutrients, and there is a lot of controversy about what nutrients and how much of them HIVers need. The answers remain somewhat elusive for several reasons. First, nutrient needs are a very personal thing, especially in the case of HIV infection, where one person is not the same as another for level of infection or its consequences, family history or predisposition to nutrition-related problems, and social or behavioral practices. Second, dietary intake of nutrients doesn't always yield improvements in nutrient use or levels. We really don't even know what is 'normal' in the context of HIV infection or how to reliably test many nutrient levels in the face of infection. Low levels of a nutrient in the blood do not always mean that there is a dietary deficiency. For instance, during infection iron tends to be sequestered in a storage form that is less available to the body for everyday use. However, supplementing iron can be tricky. Supplementation can continue to increase amounts of iron stored without making any more available to the body. The result can be toxicity (to the liver in this case) without resolving the problem. Another problem is that nutrients'even antioxidants'compete with each other. And, while a larger amount of antioxidant intake has often been recommended, it still needs to be balanced with other nutrients. For instance, green tea is touted for its wonderful antioxidant content. But if you drink a lot of green tea, those antioxidants compete with others for absorption, and you can end up with a deficient intake of important antioxidants that green tea might not provide. The elusive 'truth' is complex and not well enough understood at this point. Research to get to a solution beyond the idea that high intakes are 'associated' with some benefit may not always mean that there is a cause-and-effect relationship between supplementation of nutrients and beneficial outcome for everyone in the population studied. How does one balance nutrient intake in the face of changing needs in infection? Routine supplementation typically includes safe levels of nutrients. Thus, the old and boring idea of balance becomes enticing as a foundation. Concentration on a varied and balanced diet that emphasizes food sources of nutrients could be a safe and sustainable way to meet nutrient needs for people living with HIV infection. This is not to say that an individual might not need more of some nutrients'or even pharmaceutical doses'but that type of recommendation is likely to be safer when it is based on a valid individual assessment.