Nutrition and HIV Infection: Experience in Zimbabwe: Interview with Lynde Francis.

Lynde Francis is the founder and director The Centre, in Harare, Zimbabwe, an organization run by and for people living with HIV. She is also the regional contact for Southern Africa for the ICW, the International Community of Women Living with HTV and AIDS. We met Ms. Francis several years ago in San Francisco, and interviewed her for this article in Durban, South Africa on July 13, 2000.

These suggestions developed from her experience in Zimbabwe; we do not suggest that they be applied literally or mechanically in very different environments, such as the U.S. But we do believe her results and experience are worth knowing.

AIDS Treatment News: What are some of the most important lessons you have learned about nutrition and HIV treatment, both for Africa and elsewhere?

Lynde Francis: In the developing world, nutrition is often the only form of therapy available. We have learned that with correct nutrition, which includes vitamin supplementation and a holistic approach to HIV, you can maintain health almost indefinitely if you start early enough. And if you start when someone is already ill, nutrition together with treatment of opportunistic infections can put them back on their feet and back in employment.

Also, when people are on pharmaceutical treatment, nutrition supports them; you can use nutrition as a way of avoiding side effects, and reconstituting the immune system together with the drugs.

ATN: What approaches to nutrition do you recommend?

Francis: The rule of thumb is unrefined, unprocessed foods, low fat, no sugar, and avoiding stimulants like caffeine. By unrefined food I mean, if you eat bread, it should by whole wheat bread; if you eat rice, it should be unpolished, brown rice. If your staple is maise meal, as it is in many parts of Africa, it should be stone ground maise meal. It could include other grains like rye, like wheat used as a rice which is delicious; it could include sorghum, which is the traditional grain which was used throughout Africa before maise came in.

The proteins you take in should be as much as possible beans, lentils, peas, nuts, soya proteins, plus chicken and fish. Pork should be avoided, and fatty beef products should be avoided.

As far as possible avoid foods that have additives, like coloring, flavoring, or preservatives. And eat foods which are fresh and preferably indigenous, grown where you live. It's a rule of thumb that if it grows locally, it's going to be good for you and it's going to be appropriate because it will grow at the right season.

Clean water of course is an absolute must; so if you don't have access to clean water, it's vital that you properly filter, purify, or boil.

We recommend a low-fat diet. One of the big exceptions to that is yogurt. Yogurt is like a magic food, as is garlic. Yogurt helps to control thrush. Sugar feeds thrush, so we advise people to cut sugar out of their diet as much as possible.

Garlic is a natural antibiotic and antiviral.. It is also extremely good for thrush. And you can use it for vaginal as well as for oral thrush.

We recommend that food be prepared freshly if possible, and that much of the vegetable and fruit intake be raw--salads and raw fruit and vegetables, which maintains all the vitamin and mineral content. At least 30% of your intake of food daily should be vegetables and fruits. Fifty percent should be whole grains. Fifteen percent should be proteins. And then 5% is the cherry on the cake--it's whatever else you want, avocados, cheese and eggs--with a proviso that when you have diarrhea, you should avoid dairy products, and avoid all fat.

We mostly use locally available treatments in Africa, because usually we don't have access to drugs. For example, aloe vera is wonderful for herpes sores; slit the leaves open, and the gel inside, when applied to sores and itching of shingles, is miraculous. Another herb that's very good for this condition is comfrey, making a poultice of comfrey leaves.

We teach people in Africa recipes that are useful in difficult times, like when you have diarrhea and wasting.

It is harder to teach good nutrition in the developed world. In Africa we do not have three generations of junk food to deal with. We all can remember our traditional cuisine. In European countries and the U.S., this is more difficult.

You need to think in terms of the five rules: unprocessed, unrefined, low fat, no sugar, and one other rule, which is little and often. It is more applicable to people who have wasting, but it's applicable to anybody who wants to keep up their appetite, which is to take small, attractive meals more often. Rather than large heavy meals twice a day, take small meals five times a day. Those are the basic rules.

ATN: Where can our readers get more information?

Francis: We have a booklet, Food for People Living with HIV, which is applicable everywhere in the world. It has recipes, it has a vitamin and mineral chart, it gives the kinds of herbs and spices that can be used as therapies--what's cooling, what's heating, remedies that can be used to treat sores.

ATN: What vitamin and mineral supplements do you include?

Francis: We call it ZACES; that's an acronym that we developed to help people remember the vitamins and minerals. It's zinc, vitamin A, vitamin C, vitamin E, and selenium. We call this the infection fighting, immune boosting combination. We recommend that all our patients take supplements of these. Even an adequate food intake is not enough to deal with the level of immune suppression that happens in HIV disease. We give them diet sheets, and recommend that the supplements be taken in a balance.

ATN: For the vitamin A, could they use beta carotene instead? I am reluctant to suggest vitamin A, because people might take too much.

Francis: We have a problem getting beta carotene, because it is very expensive for us. So we recommend that they take vitamin A. It really works--especially when it is supplemented with 20 mg of zinc daily, which is very cheap for us to get.

ATN: What is the mission of your organization (The Centre, in Harare, Zimbabwe)?

Francis: Our mission, basically, is to teach long-term survival techniques to people living with the virus, based on nutrition and a holistic approach.

I urge people to look more to nutrition as an adjunct to therapy, or as an alternative to therapy. It's amazing the resuscitation that we see--people who come in and they are terminally ill, and you put them onto an adequate nutrition regime and give them vitamin supplements, and it's like Lazarus, it's like the way people describe what happened with the antiretrovirals. We have seen people recover completely just from getting their nutrition intake adequate, and getting help on coming to terms with and managing their disease.