Diet taboos for tuberculosis patients

The first is high-risk foods that will increase the burden of liver metabolism (after all, anti-tuberculosis drugs themselves have certain hepatotoxicity), the second is foods that will clearly affect the absorption of anti-tuberculosis drugs and even cause adverse reactions, and the third is irritating foods that may aggravate existing symptoms such as coughing and hemoptysis. In addition, most of the "taboo requirements" spread online are misunderstandings that have no clinical basis and may even slow down the pace of recovery.

I met a 21-year-old girl in the outpatient clinic a while ago. She was diagnosed with secondary tuberculosis three months ago. She has lost just over 70 kilograms. She staggered when she walked in. Her blood albumin was so low that she needed intravenous infusion of albumin. When I asked about it, I found out that she had heard from the elderly at home that "all hairy things" should be avoided for tuberculosis. In the past three months, she only dared to eat white porridge and boiled vegetables, and even dared not touch eggs, saying that eggs were "hairy things" and would aggravate the condition. In fact, this is really the biggest misunderstanding about the tuberculosis diet. Tuberculosis itself is a high-consuming disease, and the body's demand for protein and calories is about 30% higher than that of healthy people. Indiscriminate food intake and pinching out nutrients is equivalent to "handing a knife" to the tuberculosis bacteria.

Let’s start with the least controversial thing that all patients must avoid 100%, which is alcohol and tobacco. Regardless of whether your liver function is stable or you have symptoms, you should not touch even a drop of alcohol - rifampicin and isoniazid in anti-tuberculosis drugs themselves will put metabolic pressure on the liver, and alcohol will double the risk of drug-induced liver damage, and in severe cases, it may even lead to liver failure. Not to mention smoking. The harmful substances in smoke will directly damage the respiratory mucosa, aggravate the symptoms of cough and sputum, and slow down the absorption of lung lesions. Many patients who could have stopped taking medicine in half a year have to wait for more than a year because of secretly smoking. Also, don’t take blindly those “liver-protecting health products” and “anti-cancer miracle drugs” of unknown origin. I have seen several patients whose liver function had always been normal, but after taking Ganoderma lucidum spore powder for three months, their transaminases increased to three times the normal value. Instead, they had to stop taking the medicine to protect their livers.

As for foods high in fat, sugar, and cholesterol, such as fried foods, fatty meats, and animal offal, that doesn’t mean you can’t touch them at all. If your liver function tests are stable for two or three consecutive months, it is perfectly fine to eat a bite of fried chicken drumsticks or two pieces of pork belly if you are craving for it, and there is no need to feel any psychological burden. However, if drug-induced liver damage has been detected, or even symptoms of jaundice and loss of appetite appear, these foods must be temporarily put away, otherwise it will only increase the metabolic burden on the liver. It is not too late to eat again after the liver function has recovered.

In addition to liver problems, many people don't know that problems may occur if the food they eat and anti-tuberculosis drugs come together. The most common one is milk. Many people are used to taking medicine with a cup of warm milk. In fact, ingredients such as rifampicin and isoniazid will combine with lactose and protein in milk, affecting the absorption of the medicine, and the effectiveness of the medicine may be reduced by 30 to 30%. It’s not that you can’t drink milk. As long as it’s separated by more than 2 hours from taking medicine, it’s okay to drink two boxes a day. On the contrary, it can supplement high-quality protein and calcium. There is also spinach, which is the most frequently asked question. It is said on the Internet that tuberculosis patients should not eat spinach. This is actually because spinach contains high oxalic acid content, which easily combines with calcium in the body to form calcium oxalate. If you have low blood calcium, or have tuberculous pleurisy and are absorbing pleural effusion, you should eat less, or blanch it before eating. Most of the oxalic acid will be removed and there will be no effect. ； If your blood calcium has always been normal, it is perfectly fine to eat spinach soup or spinach salad every day, and there is no need to kill you with a pole. There are also stale sea fish that have been stored for two or three days, such as mackerel and tuna. Their histamine content is very high. When combined with isoniazid, it can easily cause allergies, dizziness, and rashes. However, fresh fish, shrimp, and seafood are all very good sources of protein. Just eat them boldly. Don’t confuse the difference between “stale fish” and “all fish.”

There is another type of taboo that depends on your symptoms and is not a one-size-fits-all requirement. If you are coughing up blood recently, or are coughing so much that you can't sleep at night, stay away from spicy hot pot, iced drinks, and salty pickles for the time being - I just admitted a 62-year-old patient last month, and the hemoptysis had just stopped for 3 days. I couldn't help but sneak out to eat a bowl of spicy Chongqing noodles. That night, I coughed up blood again, and was almost in danger. But if you have been taking the medicine for two or three months and have no symptoms at all, and the lesions are slowly being absorbed during the review, and you occasionally eat spicy home-cooked food and drink half a glass of iced Coke, there will be no problem at all, and you don’t need to set so many rules for yourself.

Every time I tell patients this, someone always asks, "Then why do people in my hometown say we can't eat roosters or mutton?" ”To put it bluntly, in the past, people had poor nutritional conditions, weak digestion when sick, and would easily get upset after eating greasy food, which is why these "fat foods" were rumored to be popular. Now, as long as you don't feel uncomfortable after eating them, you are encouraged to eat more of these high-protein foods. After all, the core of tuberculosis recovery has never been "you can't eat this and you can't eat that", but to eat enough and enjoy it well. Only when the nutrition keeps up with the immune system can the immune system be up and the medicine can have the greatest effect, which is more effective than any dietary taboos.