There's nothing worse than trying to stuff food down when you don't want to because you have no appetite. And then, when you do force yourself, everything tastes awful," says San Antonio, Texas PWA Maria Gonzalez. Unfortunately, Gonzalez has lots of company. Appetite loss, and the taste and smell changes that can contribute to it, affect many people with HIV and can lead to inadequate food intake and, ultimately, wasting.
This problem should always be reported to a physician. A number of the possible causes -- infections, drug side effects, depression and abnormal levels of hormones (such as testosterone, often too low) or cytokines (cell-produced chemicals such as tumor necrosis factor that are often too high) -- must be medically addressed.
But a major, frequently ignored cause of appetite loss is a deficiency of specific nutrients. That's something you should remedy to break the vicious circle in which the deficiencies cause appetite suppression, which then worsens the deficiencies because you don't eat enough. If this occurs, you may have to go by the clock, forcing yourself to eat regular meals at set times, even if you're not hungry.
Nutrient supplementation may also help. Eve Prang Plews, a nutritionist with a large HIV practice in Sarasota, Florida, says: "A zinc deficiency often causes appetite loss due to taste and smell distortions which make foods taste odd and unappealing. Many other nutrient deficiencies can worsen appetite problems." Prang Plews suggests taking zinc (75 mg per day), along with a good multiple vitamin-and-mineral formula and three nutritious meals daily. She adds, "When replenishing nutrients makes food taste good again, appetite often comes rushing back."
Meanwhile, make sure every bite is nutrient-rich. Skip the empty-calorie foods like candy, other sugar-loaded products, soft drinks, coffee and tea. They'll make you feel full and prevent your eating the nutrient-rich foods you need. If the prospect of eating seems overwhelming, try to make it easier. Soups made with lots of vegetables (for the nutrients), plenty of chicken, turkey, fish, beans or tofu (for the protein) and plenty of rice, noodles, corn or beans (for the calories) can be valuable as quick, easy-to-prepare, easy-to-eat meals or snacks.
Until taste and smell normalize, try new seasonings or different foods as substitutes for those that taste strange. Play with herbs and seasonings that have a strong smell (oregano, garlic, onion, lemon or lime juice, or anything else that's appealing). A hot Indian chutney or curry sauce can mask almost any other flavor. Or use Maria Gonzalez's solution: "I drowned everything in salsa until my zinc and other supplements brought normal tastes back."
Since taste distortions (particularly metallic or bitter tastes) most often affect red meats, another approach is switching to fish or poultry. Or get your protein from eggs, beans, grains, seeds, nuts and dairy products. You can also disguise an unpleasant-tasting food by submerging it in a seasoned soup or stew.
Don't limit yourself to what others think is an appropriate meal or snack time. Eat whatever's appealing to you (as long as it's nutrient-rich) whenever the mood strikes. If you want pasta for breakfast and oatmeal for dinner, go for it. Just keep those calories and nutrients coming in as often as possible throughout the day.