Sushi Do or Don't?

[Cubwithaheart]

I guess that is pretty much the question. I love it.. But is it something I should still eat or just leave out of my diet?

Thanx for the help
Cub

[Ann]

Cub,

What's your CD4 like? If you're over 200, I wouldn't worry about it, as long as you're going to a reputable place.

Ann

[Cubwithaheart]

Hey Ann,

At last check my CD4 was 640 So I guess I'll keep my plans for Sushi Saturday then..

Thank ya
Cub

[Ann]

You're welcome, Cub. And welcome to the forum too. I forgot to say that before.      

Ann

[Cubwithaheart]

Thank ya for the welcome Ann.

[betonet]

Do not overdo it, mate.
 Raw fish has sometimes much parasites in it and can lead to some health issues.

[J.R.E.]

I've never eaten Sushi. I don't even like the way it looks.  There's a Chinese restaurant that we frequent every week. And they have the "warning sign" placed at the Sushi counter. I don't know if the placing of the sign is a state thing, or federal thing, but it's in all Chinese, and Japanese restaurants.   It States that if you have a compromised immune system , you should avoid the Sushi !


Ray

[aztecan]

I would agree that people with HIV should be cautious.

In fact, I would up Ann's recommendation to those with less than 500 CD4s should avoid sushi, or any uncooked or under cooked animal product.

That would include rare beef, lamb or pork (ugh - I was raised that rare pork was a no-no and I still can't eat it rare.)

That also would include seared tuna (also not one of my favorites).

The reason is those who have compromised immune systems are at many times greater risk of developing food born illnesses such as salmonella, listeriosis, etc.

That raises another issue - cheese. Soft ripened cheese is just fine for those with normal or near normal immune systems. But I would be cautious if my CD4s were below 500 and would avoid them like the plague were my CD4s below 200.

These would include brie, camembert, roquefort, bleu, etc. Also, check the labels and make sure the cheese is made with pastuerized milk. If not, I wouldn't buy it.

These guidelines have been around since pre-cocktail days. Even so, they do apply to anyone who is living with fewer than optimal T cells.

HUGS,

Mark

[northernguy]

After diagnosis I stuck to rolls which contained cooked fish, not raw, or vegetarian.   I've backslid a bit but so far no ill effects.

[Merlin]

I still eat sushi occasionally but moderately and so far I'm ok. I laced my sushi with thick layers of wasabi cos I just luv wasabi. My CD4 is close to 500, give or take a sushi.  Perhaps if u soak your raw fish in saki ( if u dun like wasabi too much) before u chomp it down may help. This way u can have have your raw fish+drunken dead worms and eat it too....

[planonstaying]

I was told not to by a naturopath. I don't know why I asked I knew I would anyway. It's not like I don't eat other foods with health risks and my cd4s are good

[Ric Wilke]

Hey Cub,

I've never eaten sushi as Hubby is not interested.  But being of German descent I'm a huge fan of steak tartare, piled on a slice of dark rye bread and doused with pepper, then topped with raw onoin covered with sea salt.  I'll take this over a burger any day of the week.  (Just for the record, I do avoid the raw egg on top.)

[Miss Philicia]

The only time I've been warned by an HIV specialist about sushi was when I was at 160 cd4s, and perhaps up into the ~200's.

These days I think nothing about eating minimally aged cheeses like these:

http://www.cowgirlcreamery.com/cheeses.asp

[Cubwithaheart]

I decided to just stick with the veggie rolls and the tempura shrimp Since my diagnosis I been eating alot better. More Veggies and fruits. I haven't had fast food in over a month. That in it's self is amazing.

No drinking. I tend to do lots of dumb things when I drink. I'm still trying to figure out if I want to add any supplements other then my daily multivitamin into my diet.

Thanks everyone who posted. I'm gonna play it safe for alittle bit before I jump back into "real" sushi lol

[Ann]

I tend to do lots of dumb things when I drink.

Join the club, mate!

I tend to do lots of dumb things when sober too, but that's a whole 'nuther thread!

Good for you for improving your diet. That's always a good thing.

Ann

[NYCguy]

just my 2cents but I love sushi, tartare anything, rare steak and seared tuna.  My t-cells are high but I've never had any problem.  I did have amoebas last year, but I suspect that was from 'eating' a certain non-food item I won't go into here.  And even if it was from sushi, it's easily treated.

My feeling is if your t-cells are anywhere in the remotely normal region, like above 400 or so, you're probably fine.  Just for ref: GMHC does advise against sushi, but I think they are overly cautious.

I just hate to see people staying away from this wonderful and generally very healthy food, just because of a stupid virus!

[risred1]

Why not ask....

Should I eat Peanut Butter, Hamburgers, Spinach, Chicken, Eggs....

I don't know why we single out sushi.... with the health scares we've had over the years with bacteria in food we don't expect to have a problem with, why are we paying special attention to raw fish?

I have eaten sushi for years and years, and I have never have I heard of a problem in the Philadelphia area.

We should be cautious, but we also need to know where the risks are. Eating hamburger meat from a reputable butcher grinding their own meat from steak is far different than buying premade factory burgers.

I don't want to go over the top. Right now with my CD4 being under 300, I guess i should be a bit more observant.

Maybe the guidance should be to avoid factory processed foods....

[aztecan]

Actually, the guidelines I mentioned were put into use prior to the advent of triple-drug cocktails.

That said, low T-cells are low T-cells, then or now.

It isn't that I am paranoid, but I am very much aware how risky eating raw foods could be.

Anisakiasis is caused by the ingestion of nemotoad (roundworm) larvae found in raw seafood. These larvae are small and not always visible and can become permanent residents of your intestines.

Source: http://www.dpd.cdc.gov/dpdx/HTML/Anisakiasis.htm

Listeriosis can be contracted from undercooked meats or poultry or soft-ripened cheeses.

How can you reduce your risk for listeriosis?

General recommendations:

Thoroughly cook raw food from animal sources, such as beef, pork, or poultry.
Wash raw vegetables thoroughly before eating.
Keep uncooked meats separate from vegetables and from cooked foods and ready-to-eat foods.
Avoid unpasteurized (raw) milk or foods made from unpasteurized milk.
Wash hands, knives, and cutting boards after handling uncooked foods.
Consume perishable and ready-to-eat foods as soon as possible

Recommendations for persons at high risk, such as pregnant women and persons with weakened immune systems, in addition to the recommendations listed above:

Do not eat hot dogs, luncheon meats, or deli meats, unless they are reheated until steaming hot.
Avoid getting fluid from hot dog packages on other foods, utensils, and food preparation surfaces, and wash hands after handling hot dogs, luncheon meats, and deli meats.
Do not eat soft cheeses such as feta, Brie, and Camembert, blue-veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, and Panela, unless they have labels that clearly state they are made from pasteurized milk.
Do not eat refrigerated pâtés or meat spreads. Canned or shelf-stable pâtés and meat spreads may be eaten.
Do not eat refrigerated smoked seafood, unless it is contained in a cooked dish, such as a casserole. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or mackerel, is most often labeled as "nova-style," "lox," "kippered," "smoked," or "jerky." The fish is found in the refrigerator section or sold at deli counters of grocery stores and delicatessens. Canned or shelf-stable smoked seafood may be eaten.

Source: http://www.cdc.gov/nczved/dfbmd/disease_listing/listeriosis_gi.html


Campylobacteriosis is spread through undercooked poultry, although it can come from other sources. It is sometimes spread by someone who handles uncooked poultry or through contaminated ice when uncooked poultry is placed next to precooked foods without a barrier between them. This is sometimes seen in grocery stores.

Campylobacteriosis is an infectious disease caused by bacteria of the genus Campylobacter. Most people who become ill with campylobacteriosis get diarrhea, cramping, abdominal pain, and fever within two to five days after exposure to the organism. The diarrhea may be bloody and can be accompanied by nausea and vomiting. The illness typically lasts one week. Some infected persons do not have any symptoms.

In persons with compromised immune systems, Campylobacter occasionally spreads to the bloodstream and causes a serious, life-threatening infection.

Source: http://www.cdc.gov/nczved/dfbmd/disease_listing/campylobacter_gi.html

The point is not to become absolutely paranoid about all food. It is to use common sense. If you are in reasonably good shape and you believe you could fight off a food borne disease, then go for it, whatever it is.

But if someone has fewer than 500 CD4s, they may want to err on the side of caution when it comes to some of these foods. For someone with fewer than 200 T-cells, it would be my opinion this should be rote.

HUGS,

Mark

[risred1]

First, Mark you always come through! Great to have this information.

Here's a way to put risk into some perspective. And how we consider risk is all about perception.

I was having diner with a friend and his partner and while he was getting drunk on Wine and chain smoking cigarettes, he pointed out over coffee that he would never use Nutrasweet because it can give you brain tumors.

Of course I had to barb back about the cigs and the drinks... From that point on, I don't think he liked me.

 

We just went through this whole scare with Swine Flu. In fact its not over. How many of us, especially us, were concerned. We should be concerned. If we get the flu, it of course can be fatal for us.

But how do we then manage ourselves? What should we be doing?

Being "prudent" may simply be aware and thoughtful about the situations we put ourselves in. We can only do so much to protect ourselves. In fact, that we are HIV positive is partly a testament to that fact.

Every day there is something to be scared of. Yet, how often is it that those things we are advised to be scared of are in fact the thing that we really should be thinking about?

Like my friend with the cigs and the drinks looking at Nutrasweet and thinking, Brain Cancer!

Even the "healthy" stuff. Remember the Spinach e-coli scare?

I guess awareness and thinking before you act is really the goal, to limit opportunities for food borne illness.

I'll still have a rare burger, but if I go to a picnic and see the frozen factory burger coming out... well, it better be a hockey puck by the time it hits my plate.

 

[NYCguy]

Marks great posting inspired and reminded me that I forgot to stand momentarily on my soap-box: 

Irradiation!!

If this country would just get over it's irrational fear of anything with the word 'radiation' in it (I mean, duh, how many of us have microwaves and yet never seem to worry that the popcorn will be bleeding radiation when we pull it out) and find cheap, fast ways to irradiate on a large scale, the Jack-in-the-box deaths, the spinach scares, and many, many other food-related illnesses could be virtually eliminated!

Irradiation doesn't affect taste or anything like that.  Plus it increases shelf life exponentially.  The problem is, they don't make personal irradiators and currently need to be done in large machines. It has always seemed like a no-brainer for things like sushi, but there would have to be a shift in attitude for it to be generally adopted.   Maybe this should become a cause celebre for the HIV community... told you I was getting on my soap box!

Be happy to hear comments, tirades, beratings, et al. on this topic.

[risred1]

You'll get no argument from me.

Just like with the stigma associated with HIV... the fear of radiation, drilled into us by Hiroshima and magnified by the cold war, and three milie island, is of course overblown.

Hey, we all found out we need a bit of radiation to get our bodies to produce the vitamin D we all need to be healthy.

And we use radiation for X-Rays of course.

Of course we need to know for sure that its safe... but I'd be actually happier if food borne illness's could be irradiated out of food.

But there is one cost here and probably not for us...

There is concern that we lead a too clean life. That we are not interacting enough with Bacteria and virus's, which in fact weakens the immune system. Our obsession with bacteria may in fact be working against us...

Food for thought? (sorry!)

[tokyodecadence]

I love sushi. I like to live in the wild side. I'll eat that sushi up.




I'm a rebel. 

[GNYC09]

Bummed to hear about the soft cheeses (esp. brie).  Oh well, it's better to be safe than sorry.

[mewithu]

 Sorry Man I think your going to have to foget abut eating Sushi. Bad for Immune system indeed,Sorry.
 
 Sincerely'
 Jerry

[andysdaddy]

This is the first I've ready about sushi & undercooked meat (I just started dating an hiv+ guy & I'm trying to read all I can).  Anytime we eat out he always orders steak medium rare, his fish medium rare when he can, & he loves sushi.  Should I be concerned?  I mentioned this to him & he basically ignored me & said it was nothing to worry about.  Any thoughts?

[sharkdiver]

I  love sashimi; had a big plate of red ahi the other night. As long as my counts are decent, I'm not going to worry about it.

[sharkdiver]

oh and I would HATE for some neggie to tell me what I could or could not eat. That's for me to decide 

[Miss Philicia]

oh and I would HATE for some neggie to tell me what I could or could not eat. That's for me to decide 

Yeah really.  I'd be giving that person the ole heave-ho in about five minutes.

[veritas]

I know a lot of people like Sushi and certainly no-one can force you to eat or not to eat Sushi, however,
any fish or meat that is uncooked carries the possibility of food bourne illness. It depends on the risk your willing to take. Many HIV- people get sick from raw fish or meat so roll the dice if you like.

http://www.poz.com/articles/231_7408.shtml

There's quite  a few things I used to like to do that I don't do anymore since being poz. I usually found out that those things weren't as important as I thought.

v

[Miss Philicia]

At 1300 cd4 I figure I have more t-cells than many non-infected people, so I eat whatever I damn please.

That +decade old link below specifically mentions "PWA" so I'd infer it's aimed at folks with less than 200 cd4.  The only time I was cautioned about sushi by a doctor was when I was floating around the 150-300 cd4 level fifteen years ago or so.

[veritas]

You do what you want Miss P ----- For those who want more info here's another link:

http://www.bcpwa.org/articles/issue_12_30-31_and_33_sushi.pdf

By the way, the age of a link doesn't necessarily mean it's outdated.  The cautionary stance is for all people HIV+ no matter what your cd4 cell count is.

Perhaps Miss P can provide a link that shows it's fine to eat Sushi if you are HIV+.

v

[sharkdiver]

oh god   

[Ann]

You do what you want Miss P ----- For those who want more info here's another link:

http://www.bcpwa.org/articles/issue_12_30-31_and_33_sushi.pdf

By the way, the age of a link doesn't necessarily mean it's outdated.  The cautionary stance is for all people HIV+ no matter what your cd4 cell count is.

Perhaps Miss P can provide a link that shows it's fine to eat Sushi if you are HIV+.

v

From the above article (emphasis mine):

The Bottom Line

Eat at your own risk. The lower your CD4 is the higher the chance that you will get a food-borne illness from eating raw fish or sea foods. If your CD4 is lower than 200 you should really consider whether your enjoyment of these foods is worth the risk.

This article is saying what Sharkie and Miss P have been saying. If you've got decent numbers, you have no more reason to worry about eating sushi than an hiv negative person. You have to remember that the parasitical, bacterial and viral illnesses associated with sushi are a possibility whether or not one is hiv positive. A person with good CD4s aren't actually considered "immuno-compromised".

This is very much a personal choice. People know their own bodies - and a negative person insisting they know what a positive person can and cannot eat clearly goes against this. How can they know that person's body? They can't and have no business trying to dictate anyone's diet.

Personally, I'd be very wary of eating sushi, not because of my numbers, but because of how well I know my own digestive system. Since I've been poz, I have to be very careful of what I eat because I'll get nausea or diarrhea MUCH more easily now than when I was neg. I used to have a cast iron stomach, but no more. However, I would never tell another pozzie they couldn't have sushi on the basis of my own personal experience, because everyone is different. I might let them know that if they have a very poor CD4 count they could become ill more easily, but they probably already know that. It's their own personal decision.

It's one thing to be aware of the possible  risks and something totally different to scare-monger that ANYONE who is poz, regardless of personal situation, will become sick from eating sushi. It's the same as insisting negative people will also get sick. They might, they might not. The risks of eating raw foods are there regardless of serostatus.

Ann

[Ann]

Oh, and another thing...

By the way, the age of a link doesn't necessarily mean it's outdated. 

Nine times out of ten, when you're discussing hiv, the age of the link DOES mean the information is outdated.

Ann

[Miss Philicia]

oh god   

[veritas]

Ann,

You seem to have left this quote out of your arguement:

Q What is the recommendation
for people with HIV eating
sushi?
A: The strong recommendation for all
persons living with HIV is to avoid eating
raw meats, fish and sea foods, and
eggs regardless of CD4 counts or viral
loads.
Thats the recommendation period. Unless you have any linked information to the contrary, then you are providing the wrong information. Anyone can do anything they please as I stated before, if one is willing to take the risk. Being informed is not fear mongering. It allows one to make a competent and educated decision. Try one of the following  ------ they make the side effects of ritonavir look desireable:

Anisakiasis
Diphyllobothriasis
“fish tapeworm infection”
Clonorchiasis “Chinese liver fluke”
Gnathostomiasis
Angiostrongyliasis
Vibrio
E Coli
Samonella
Listeriosis

I did not make-up the recommendation --- so I guess you decide what recs to follow?
Nelson Vergil said it best:"I love Sushi, I eat it all the time only in those months beginning with R."

Roll the dice if you like, but the bottom line is it is not recommended ----- I believe that was the original question answered. Ann sometimes you make me laugh with your statements. Show me where 9 times out of 10 when your discussing HIV the age of the link matters. Another statistic pulled out of your head.Of course there will be situations where old data is up-dated to reflect newer results especially concerning drug interaction and AEs thus the qualifier in my statement "necessarily'.

Let's stop trying to be "Frat" boys and provide the correct information.

You might not like what I say, however, I back my statements up with links. You should do the same!

v

[Ann]

All the problems listed can and do affect people who aren't hiv positive. Ask ANY doctor and they'd tell you that it is strongly recommended that raw meat, fish and eggs are not consumed by ANYONE. In fact, I was reading an American restaurant's menu online the other day, and on every page they had a disclaimer to the effect that eating raw or under-cooked meat, fish or eggs was not recommended, but it was the diner's choice. It said nothing about being hiv positive or otherwise immuno-compromised, it was aimed at everyone.

That's the point I'm trying to get across. Eating raw or undercooked meat, fish or eggs can be dangerous for ANYONE, regardless of hiv status. To single pozzies out, regardless of CD4 counts, is simply scaremongering.

Ann

[Ann]

Ann sometimes you make me laugh with your statements. Show me where 9 times out of 10 when your discussing HIV the age of the link matters. Another statistic pulled out of your head.Of course there will be situations where old data is up-dated to reflect newer results especially concerning drug interaction and AEs thus the qualifier in my statement "necessarily'.


You might not like what I say, however, I back my statements up with links. You should do the same!

v

I'm glad I provide a little light relief for you.

I didn't exactly pull any statistics out of my head - my comment was personal observation based on years of reading about hiv. Anyone with a bit of sense would have known I wasn't trying to provide a statistic.

And as for links, here's the menu I read. I paraphrased their discliamer, but what was actually said was this:

Consuming raw or undercooked meats, poultry, seafood or eggs may increase the consumers risk of foodborne illness.

Vida at the Fontainebleau Hotel

Ann

[Miss Philicia]

Veritas, can you provide recommended guidelines for HIV-infected individuals that show the difference between what one does at 0-200 cd4, 200-600 cd4, and above 600 cd4?  And if there is not a link separating out these differences, then explain why this is so.  Also, in your own words, what is the difference between someone with 1200 cd4 that is HIV infected and someone that is not HIV infected in terms of food consumption? -- not just sushi, but also things like tap water, etc.  Also, compare and contrast food recommendations for pozzies as regards cultural attitudes of raw foods between say, USA and Japan or USA and France.

[veritas]

Meum cerebrum nocet !

[Miss Philicia]

Fascinating analysis.

[Ann]

Well, V, if your brain hurts, maybe you should see a doctor.

[veritas]

Ann,

The Fountainbleau Hotel's menu has nothing to do with the recommendations for eating Sushi if you are HIV positive. The recommendation is  " it is not recommended" for HIV positive people period. So don't cloud the issue. This has got to be a joke.

Miss P,
The thread was discussing Sushi and whether or not it is recommended to eat if your HIV+ and the answer is that it is not. If you are having problems following proper nutrition, being an HIV+ person --I can refer you to the book "Built To Survive" an HIV wellness guide by Michael Mooney and Nelson Vergel - fourth edition.
 Please don't try high school debate tactics to cover your decision to eat what is not recommended, I know your perfectly capable of googling all that information yourself. It won't work.

v

[Miss Philicia]

So you couldn't answer my question and now you're resulting to insults.  Where's that high school located?

[veritas]

Miss P,

You'll get no justafication from me for your decision. How that is "resulting" to insults when you are using the tactic is difficult to understand or perhaps I'm giving you too much credit?

Bottom line -- If you wish to eat Sushi, so be it.

Ann,

Here's another one for you:  Non ut edam vivo, sed vivam edo ! ( that means no Sushi!)

v

[Miss Philicia]

Dr. Gallant on HIV and sushi:

(also note in the provided link that the patient posing the question has a cd4 count of 449)

link

Q:
Posted on Aug 4, 2009
Raw food: Regardless of the VL/CD4 result and the cleanliness of a restaurant, is eating sushi/sashimi would no longer be allowed at all times? I do occasionally eating salad at home so I can wash thoroughly.

A:
On Aug 8, 2009 Joel E. Gallant, M.D., M.P.H. replied:
Some doctors recommend against sushi or sashimi, but I believe it's OK, because the parasites you can get from this kind of food don't cause worse disease in people with HIV infection. Eating raw oysters or other shellfish can be more of a problem, but not in someone with your CD4 count. With your CD4 count, there are no special dietary concerns.

[sharkdiver]

Dr. Gallant on HIV and sushi:

(also note in the provided link that the patient posing the question has a cd4 count of 449)

link

Q:
Posted on Aug 4, 2009
Raw food: Regardless of the VL/CD4 result and the cleanliness of a restaurant, is eating sushi/sashimi would no longer be allowed at all times? I do occasionally eating salad at home so I can wash thoroughly.

A:
On Aug 8, 2009 Joel E. Gallant, M.D., M.P.H. replied:
Some doctors recommend against sushi or sashimi, but I believe it's OK, because the parasites you can get from this kind of food don't cause worse disease in people with HIV infection. Eating raw oysters or other shellfish can be more of a problem, but not in someone with your CD4 count. With your CD4 count, there are no special dietary concerns.

Thank you Miss P

That is exactly what my Doc told me.

[veritas]

Dr, Gallant, who by the way I respect and is also on the HIV Guideline Committee, believes it is ok, but many don't , so there is differing opinions. If it was recommended, universally, that recommendation I posted wouldn't be there. So you still role the dice. I ,for one, would not eat it

v

[andysdaddy]

Seriously?

I never said anything about what he "could or couldn't" eat.  He's an adult, he can go out in the backyard & eat dirt if he wants to.  It's no different from him looking at me when I'm about to put away an entire bag of potato chips & asking me "is that a good idea?". 

I was simply asking what people's thoughts were on the matter here since it seems to be something that's in a grey area.  Being new to all of this & recently just starting to date someone with HIV I was hoping to get a better insight into this so I can help to look after him.  He's not an expert on any of this (& clearly I'm not), it was just so that we can work together to help keep him healthy.

I wasn't expecting to be insulted by asking what I thought was a harmless question.

Yeah really.  I'd be giving that person the ole heave-ho in about five minutes.

[veritas]

andysdaddy,

I applaud you for wanting to keep your BF healthy and let me suggest again the book:"Built to Survive"
fourth edition. That book will give you an overview as to how to stay healthy with HIV and a good starting point if you are just learning about the disease.

i wish you both well!

v