While in HIV disease a "proper diet" has yet to be defined, I think that most would generally agree that low-to-moderate amounts of sugar are okay. In cases of yeast infection, it may be of benefit to restrict sugar intake to only low amounts. Since yeast infections can be of serious consequence, always consult a physician regarding any infection. A number of studies (both intervention and epidemiological types) indicate an association between high sugar intake and yeast infections, certain types of cancer and immune suppression.

High levels of sugar have been shown to impact negatively on immunity, reducing both lymphocyte and neutrophil activities. With HAART (Highly Active Anti-Retroviral Therapy) treatment there is also the possibility that there is interference with the body's ability to utilize the essential fatty acids as a result of inhibition of one of the enzymes that enables the body to properly use these fatty acids. This enzyme has been shown to be inhibited by high levels of glucose during tube feeding. It is not clear whether or not high sugar levels in foods may do likewise. Erring on the side of caution would seem advisable. A so-called "whole foods" diet that has no added sugar should be of no concern. Low amounts of added sugar are also likely okay.

There are emergency situations when high levels of the sugar glucose (dextrose) must be given by tube (in a hospital/clinical setting). Otherwise it would seem best to stick with low-to-moderate levels. If liquid nutritional supplements ("meal in a can") are required, stick with those that provide most of the carbohydrate in the form of starch or maltodextrins rather than glucose, fructose or sucrose (table sugar). Two to three cans of those supplements containing only sugar for their carbohydrate component contain about the amount shown to cause significant immune suppression in the studies mentioned above.

Some of the references in support of this argument may be found in a monograph called "HIV and Liquid Nutritional Supplements" available at www.catie.ca, in a section of monographs written by myself.

A: Diana Peabody, RD responds:

High intakes of sugar (sugar, juice, pop, sweets) can worsen high triglycerides.

High intakes of sugar can increase the incidence of relapse in people trying to maintain sobriety in recovery from drug or alcohol addiction.

Small to moderate amounts of sugar add flavour and calories to foods and should be fine. I agree with Chester that avoiding high amounts is good idea because along with the concerns he expresses, high amounts of sugar can displace other more nutritious foods from the diet.

Q #2: Sugar (and Yeast) & HIV

I am positive, and I'm starting to hear reports about how sugars and yeasts (particularly white bread) can be very bad for me. Is it really so dangerous for me to consume normal amounts of sugars, a chocolate bar now and then, etc.?

A: Charlie Smigelski, RD responds:

Too many simple sugars may displace more nourishing calories, like a soda or two a day is hard to justify. But modest dessert portions or milk and cookies as a snack is not detrimental. Yeast in food is saccharomyces, a benign version of single-cell life form. People confuse this with yeast like the Candida of thrush and vaginal "yeast" infections. Bread is harmless, the yeast died in the baking process.

Many people take beneficial bacteria--Probiotics, for example--to prevent the growth of Candida and avoid simple sugars which may otherwise nurture too many Candida cells in the gut. In general, Candida grows because of nutritional or immune deficiencies. Candida is less well suppressed in people with less that 100 T Cells. Lack of selenium can result in greater risk of thrush growth too. Also, PI (Protease Inhibitor) therapy disturbs beneficial gut bacteria, and many also take "Probiotic" supplements to prevent diarrhea.

Occasional sugar and a chocolate bar is just fine.

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