Question: I wish to enquire about the diet "prescribed or recommended" by the health minister which has made media headlines recently. I am confused by the conflicting reports about the effects and the lasting benefits of this diet on people living with HIV and AIDS that have been circulated. We have been told through the media that this should be our "informed choice" of treatment for people living with HIV and AIDS, as opposed to antiretrovirals. What evidence is there that any of these foods consistently improve the immune response? Were human studies carried out? How effective is a diet of blended or grated lemon, mixed with extra virgin olive oil and water, crushed garlic and ginger, spinach, beetroot and vitamin supplements?

Answer: Where human studies have been carried out, the results around dietary programmes as medicinal alternatives are still contradictory and inconclusive.¹ The scientific community advocates good nutrition and ARVs.

What does the literature say about these foods?
Fresh garlic has excellent anti-fungal, antiviral and anti-bacterial properties; it also purportedly balances blood pressure and lowers cholesterol. Although some literature states that garlic is safe if taken in large quantities.²

Scientific sources advise that garlic powder can damage the gastric mucosa and that garlic supplements, taken for over 2 months, may lengthen bleeding time (interfere with clotting) and interact with ARVs.³

Like garlic, onions also help to fight infection. In one study however, onions and olive oil also failed to show any improvement to the immune system of people living with HIV and AIDS (PLWHAs), and in fact seemed hasten the onset to AIDS. The literature states that large amounts of ingested onions may cause chronic diarrhoea and intestinal distension.³ Onions as well as the African Potato previously advocated for, appear to have been omitted from the diet listed in your question.

The African Potato (Hypoxis) had mixed success. Initial studies undertaken showed promising results with PLWHAs not progressing to AIDS. In a study on the safety and efficacy of Hypoxis, the majority of patients developed serious bone marrow suppression and the study had to be stopped after 8 weeks. ³

Drinking lemon juice (2Tsp) and olive oil (1Tsp) mixed with water, once a day, reportedly increases appetite and energy levels and reduces swollen lymph glands. ²

Most sources recommend a good multivitamin especially if you cannot eat enough food for your body's needs, due to nausea or diarrhoea. A balanced diet - fruit and vegetables (including beetroot, spinach and ginger), nuts and seeds, grains, seafoods, meat, poultry and dairy products - is still the best source of vitamins and minerals, however. Please ensure that meat and fish are thoroughly cooked before being eaten by PLWHAs.

Most foods have beneficial properties, but immune-boosting foodstuffs, vitamins and supplements, if taken in large quantities, may have an adverse effect even in a completely healthy person. The immune system of a person with HIV is running amok, and the effects may be even more unexpected. Some nutrients boost the immune system as well as enhance the replication of HIV in the body. Supplements can also interfere with ARVs and it is absolutely imperative to inform your health care team of any medication, herbal medicines, homeopathic remedies, or other substances you are taking. While the CD4 cell count is only an indication of the body's immune system, the report of the CD4 cell counts improving in 2 subjects on the above diet may have given a false impression. The CD4 cell count may fluctuate by up to 80 points on either side of the count due to influences like the time of day, the previous meal, an infection or a mood shift. In both of the subjects the new CD4 cell count had improved by less than 80 points.

It is perhaps best to exercise caution, and try to find the most balanced way, and one that suits your needs, to deal with this disease. It is important to ensure that all food prepared for PLWHAs is hygienically handled to prevent infections.

¹ Nutrition Information Centre, University of Stellenbosch (NICUS), 2003
², Positive Health by Neil M. Orr. [2000]. Distributed by Metropolitan, Cape Town
³ HIV/AIDS Primary Health Care by Clive Evian. 4th ed. Johannesburg: Jacana Educational, 2003.