A well balanced diet is the surest way to meet your recommended nutritional requirements. However some studies have indicated that people living with HIV may require nutritional supplementation due to:
- An identified vitamin or mineral deficiency (e.g. iron, vitamin D and thiamine);
- increased physiological needs (e.g. during infancy, childhood and pregnancy);
- increased nutritional losses as a result of gastrointestinal problems or side effects of drug treatment;
- poor appetite;
- risk of disorders such as osteoporosis.
If you choose to supplement your diet intake with vitamins and supplements, it is generally recommend that a broad spectrum multivitamin and mineral tablet is best. Mega-dosing can lead to overdosing and the occurrence of adverse effects. Large doses of some vitamins and minerals can be toxic and can also cause unpleasant side effects such as vomiting, abdominal cramping and diarrhea. While the threshold between the safe upper limits may be small in some cases and overt toxicity is rare, the long-term consequences of excessively high intake may be significant in some cases.
Whether taking a multivitamin is beneficial or not for people living with HIV is debatable. Our article “Should I take a multivitamin“ sets out the latest research; you might also want to try our online quiz
Vitamin A
Chronic toxicity usually occurs from intakes in excess of 7500–1500 micrograms retinol equivalent (RE)/day but adverse effects may result from prolonged intake of 1500–3000 microgram RE/day. Large amounts can cause liver and bone damage, vomiting and headache. Retinol-containing supplements should be avoided by people consuming liver more than once per week and older adults at risk of osteoporosis. Pregnant women should not take supplements containing vitamin A before consulting their doctors on medicinally advised vitamin A, as high intakes could affect foetus growth.
Vitamin B6
More than 200 mg per day associated with irreversible neurological damage. Doses as low as 50 mg per day have been associated with peripheral sensory neuropathy. It is recommended that supplementary intakes do not exceed 10 mg per day (Thomas B)
Vitamin C
Doses above 1000 mg per day may lead to gastrointestinal side effects like diarrhoea and abdominal pain. The possibility that high vitamin C intake may increase oxalate excretion and increase the risk of renal stones remains uncertain. People who choose to take vitamin C supplements that significantly increase requirements (500 mg-1 g/day) may well be advised not to take them for longer than a few weeks and then to reduce the level of intake gradually. Special care is needed if taking Indinavir (Crixivan)
Vitamin E
A safe upper limit for supplemental intake has been set at 540 mg ?-tocopherol/day. Special care is needed if patients are taking anticoagulants or have haemophilia as it interacts with vitamin K and has an anticoagulant effect
Beta-carotene
Long-term intake of greater than 7 mg/day may increase the risk of lung cancer. Beta-carotene supplements should not be taken by people who smoke (Thomas, 2007)
Calcium
More than 1500 mg per day may cause abdominal pain and diarrhoea (Thomas, 2007)
Iron
More than 17 mg/day may cause constipation, nausea, abdominal pain (Thomas, 2007)
Magnesium
More than 400 mg/day may cause osmotic diarrhoea (Thomas, 2007)
Manganese
Manganese is neurotoxic at high levels of intake. It is recommended that supplemental intakes should not exceed 4 mg per day. It should not exceed 0.5 mg per day in older adults. (Thomas, 2007)
Nickel
Nickel-containing products may cause a skin rash in sensitive individuals (Thomas, 2007)
Nicotinic acid
50 mg doses of nicotinic acid can cause skin flushing and other reversible side effects such as gastrointestinal problems. Prolonged intake of higher doses may cause liver dysfunction. It is recommended that supplemental intakes of nicotinic acid do not exceed 17 mg/day (Thomas, 2007)
Phosphorus
More than 250 mg per day may cause mild stomach upsets in sensitive individuals. Long-term excessive intake may be detrimental to bone health (Thomas, 2007)
Selenium
The safe upper limit for selenium has been set at 450 microgram/day, so a maximum of 350 microgram/day should be consumed in supplemental form. Chronic toxicity may result in adverse effects on the nervous system and a condition called selenosis
Zinc
High intakes have been linked with copper and iron deficiency and gastrointestinal side effects (Thomas, 2007) It is recommended that supplemental zinc intake does not exceed 25 mg/day
