How does nutrition impact tuberculosis treatment and recovery. What are the key dietary recommendations for TB patients. Which nutrients play a crucial role in boosting immunity against tuberculosis. How can malnutrition affect tuberculosis progression and treatment outcomes.

Understanding Tuberculosis: Causes, Symptoms, and Risk Factors

Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis that primarily affects the lungs but can also impact other parts of the body. This infectious disease remains a significant global health concern, with an estimated one-third of the world’s population carrying the TB bacteria.

Common symptoms of active TB include:

• Chronic cough (often with blood-tinged sputum)
• Fever and night sweats
• Unexplained weight loss
• Loss of appetite
• Fatigue
• Nail clubbing (in some cases)

Several factors can increase an individual’s risk of contracting tuberculosis:

• Overcrowding and poor living conditions
• Malnutrition
• Weakened immune system (e.g., due to HIV/AIDS)
• Substance abuse
• Certain medical conditions (e.g., chronic lung disease, silicosis)
• Smoking
• Close contact with infected individuals

The Critical Link Between Nutrition and Tuberculosis

Nutrition plays a vital role in both the prevention and treatment of tuberculosis. Poor nutrition can lead to a compromised immune system, making individuals more susceptible to TB infection and hindering their ability to fight the disease effectively.

How does malnutrition affect tuberculosis patients? Malnutrition can:

• Reduce appetite, leading to further weight loss
• Impair nutrient absorption
• Alter metabolism, resulting in wasting
• Weaken the immune response to TB bacteria

Conversely, active tuberculosis can exacerbate malnutrition, creating a vicious cycle that complicates treatment and recovery. Therefore, addressing nutritional deficiencies is crucial for successful TB management.

Essential Nutrients for Combating Tuberculosis

A well-balanced diet rich in specific nutrients can support the body’s immune response and aid in the fight against tuberculosis. Here are some key nutrients and their roles in TB management:

Protein: Building Blocks for Immunity

Protein is essential for building and repairing body tissues, including those of the immune system. How much protein should TB patients consume? Aim for 2-3 portions of high-quality protein sources daily, such as:

• Lean meats
• Fish
• Dairy products
• Legumes and pulses
• Eggs

Antioxidants: Boosting Immune Power

Antioxidants help protect cells from damage and support overall immune function. Include a variety of colorful fruits and vegetables in your diet to ensure an adequate intake of antioxidants.

Iron: Combating Anemia and Supporting Oxygen Transport

Iron deficiency is common among TB patients and can impair immune function. How can TB patients increase their iron intake? Include iron-rich foods such as:

• Dark green leafy vegetables (e.g., spinach, kale)
• Red meat
• Fortified cereals
• Beans and lentils

Zinc: Enhancing Immune Response

Zinc plays a crucial role in immune function and has been shown to be deficient in many TB patients. Incorporate zinc-rich foods into your diet, such as:

• Nuts and seeds
• Whole grains
• Lean meats
• Shellfish

Vitamin A: Supporting T-cell Function

Vitamin A is essential for the proper functioning of T-cells, which are critical in the immune response to TB. Include foods rich in vitamin A, such as:

• Orange and yellow fruits and vegetables (e.g., carrots, sweet potatoes, mangoes)
• Dark green leafy vegetables
• Liver
• Eggs

Vitamin D: Enhancing Macrophage Function

Vitamin D plays a vital role in the function of macrophages, which are key players in the body’s defense against TB. How can TB patients ensure adequate vitamin D intake? Consider the following sources:

• Fatty fish (e.g., salmon, mackerel)
• Egg yolks
• Fortified dairy products
• Sunlight exposure (with caution and as advised by a healthcare provider)

Selenium: Supporting Overall Immune Function

Selenium is an essential trace element that plays a crucial role in maintaining immune processes. Include selenium-rich foods in your diet, such as:

• Brazil nuts
• Fish and shellfish
• Poultry
• Whole grains

Dietary Strategies for TB Patients

Implementing a nutritious diet is crucial for TB patients to support their treatment and recovery. Here are some practical dietary strategies to consider:

Increase Caloric Intake

TB patients often experience weight loss and increased metabolic demands. How can TB patients safely increase their calorie intake? Consider the following tips:

• Eat smaller, more frequent meals throughout the day
• Include nutrient-dense foods like nuts, avocados, and olive oil
• Add healthy snacks between meals
• Incorporate calorie-rich smoothies or shakes into your diet

Focus on Whole Foods

Emphasize whole, unprocessed foods in your diet to ensure a wide range of nutrients. Include:

• Whole grains (e.g., brown rice, quinoa, whole wheat bread)
• Fresh fruits and vegetables
• Lean proteins
• Healthy fats (e.g., avocados, nuts, seeds, olive oil)

Stay Hydrated

Proper hydration is essential for overall health and can help manage some TB symptoms. Aim to drink plenty of water throughout the day and consider incorporating hydrating foods like fruits and vegetables into your diet.

Limit Processed Foods and Added Sugars

Processed foods and added sugars can contribute to inflammation and provide empty calories. Focus on whole foods and natural sources of sweetness, such as fruits, to support your body’s healing process.

Consider Probiotic-Rich Foods

Probiotics may help support gut health and overall immune function. Include probiotic-rich foods in your diet, such as:

• Yogurt
• Kefir
• Sauerkraut
• Kimchi

Dietary Considerations During TB Treatment

While following a nutritious diet is crucial for TB patients, there are some specific considerations to keep in mind during treatment:

Medication Interactions

Some TB medications may interact with certain foods or nutrients. How can TB patients minimize potential drug-nutrient interactions? Consider these tips:

• Take medications as directed by your healthcare provider
• Inform your doctor about any dietary supplements you’re taking
• Avoid consuming alcohol during treatment, as it can increase the risk of liver damage
• Consult with a registered dietitian for personalized advice on meal timing and food choices

Managing Side Effects

TB medications can sometimes cause side effects that affect appetite or digestion. To manage these side effects:

• Eat small, frequent meals if nausea is a problem
• Choose bland, easily digestible foods when experiencing stomach upset
• Stay well-hydrated to help manage potential gastrointestinal side effects
• Discuss persistent side effects with your healthcare provider

The Role of Nutritional Supplements in TB Treatment

While a balanced diet should be the primary source of nutrients, some TB patients may benefit from nutritional supplements. However, it’s crucial to consult with a healthcare provider before starting any supplementation regimen.

Potential supplements that may be recommended for TB patients include:

• Multivitamin and mineral supplements
• Vitamin D
• Zinc
• Protein supplements (for severely malnourished patients)

Why is professional guidance important when considering supplements? A healthcare provider can:

• Assess individual nutritional needs
• Recommend appropriate dosages
• Monitor for potential interactions with TB medications
• Adjust supplementation as needed throughout treatment

Long-Term Nutritional Support for TB Recovery

Nutritional support should continue even after the completion of TB treatment to ensure full recovery and reduce the risk of relapse. How can individuals maintain good nutrition post-treatment? Consider these strategies:

• Continue following a balanced, nutrient-rich diet
• Maintain a healthy body weight
• Stay physically active as advised by your healthcare provider
• Attend regular follow-up appointments to monitor nutritional status
• Address any lingering nutritional deficiencies

By prioritizing nutrition throughout the treatment process and beyond, individuals can support their body’s ability to fight tuberculosis and promote overall health and well-being.

Addressing Nutritional Challenges in Resource-Limited Settings

In many parts of the world, TB patients face significant challenges in accessing adequate nutrition. How can these challenges be addressed? Consider the following approaches:

Community-Based Interventions

Community-based programs can play a crucial role in improving nutrition for TB patients. These may include:

• Food assistance programs
• Community gardens
• Nutrition education initiatives
• Cooking demonstrations using locally available, nutritious ingredients

Sustainable Agriculture Practices

Promoting sustainable agriculture can help improve food security and nutrition in TB-affected communities. This may involve:

• Supporting small-scale farmers
• Encouraging crop diversification
• Implementing water conservation techniques
• Promoting the cultivation of nutrient-dense crops

Integration of Nutrition Support in TB Programs

Incorporating nutrition support into existing TB treatment programs can help ensure that patients receive comprehensive care. This may include:

• Routine nutritional assessments
• Provision of nutritional counseling
• Distribution of fortified foods or supplements when necessary
• Collaboration with local nutritionists or dietitians

By addressing nutritional challenges at both the individual and community levels, we can work towards improving outcomes for TB patients and reducing the global burden of this disease.

The Future of Nutrition in TB Management

As our understanding of the relationship between nutrition and tuberculosis continues to evolve, new approaches to nutritional support in TB management are emerging. What are some promising areas of research and innovation in this field?

Personalized Nutrition Plans

Advances in nutritional science and technology may soon allow for more personalized nutrition plans for TB patients. This could involve:

• Genetic testing to identify individual nutritional needs
• Use of artificial intelligence to develop tailored meal plans
• Wearable devices to monitor nutritional status in real-time

Novel Nutritional Therapies

Researchers are exploring new nutritional interventions that may enhance TB treatment. These include:

• Specialized probiotics designed to support immune function
• Nutrient-dense food products formulated for TB patients
• Targeted micronutrient supplementation based on individual deficiencies

Integration of Nutrition and Drug Therapy

Future TB treatments may involve a more integrated approach to nutrition and medication. This could include:

• Development of drugs that also address nutritional deficiencies
• Nutritional interventions designed to enhance drug efficacy
• Personalized treatment plans that consider both pharmacological and nutritional factors

As research in these areas progresses, we can hope for more effective, comprehensive approaches to TB management that fully leverage the power of nutrition in fighting this challenging disease.

Diet Tips to Fight Tuberculosis

Getting the right nutrition can help speed treatment and prevention includes healthy immunity.

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis (MTB). Tuberculosis generally affects the lungs, but can also affect other parts of the body. The classic symptoms of active TB are a chronic cough with blood-containing sputum, fever, night sweats, and weight loss. General signs and symptoms include fever, chills, night sweats, loss of appetite, weight loss, and fatigue. Significant nail clubbing may also occur One-third of the world’s population is thought to be infected with TB. New infections occur in about 1% of the population each year. In 2014, there were 9.6 million cases of active TB which resulted in 1.5 million deaths. Visit Aster Hospitals, the best tuberculosis hospital in Dubai if you are infected with Tuberculosis for a top-class health care.

Tuberculosis is closely linked to both overcrowding and malnutrition, those at high risk thus include people who inject illicit drugs, inhabitants, and employees of locales where vulnerable people gather (e.g., prisons and homeless shelters), medically underprivileged and resource-poor communities, high-risk ethnic minorities, children in close contact with high-risk category patients, and health-care providers serving these patients. Chronic lung disease is another significant risk factor. Silicosis increases the risk about 30-fold. Those who smoke cigarettes have nearly twice the risk of TB compared to nonsmokers People who are malnourished or underweight are more likely to get tuberculosis,

Malnutrition can lead to secondary immunodeficiency that increases the host’s susceptibility to infection. In patients with tuberculosis, it leads to a reduction in appetite, nutrient malabsorption, micronutrient malabsorption, and altered metabolism leading to wasting. Both protein-energy malnutrition and micronutrients deficiencies increase the risk of tuberculosis. Receive a consultation at Aster Hospitals, the best hospital in Dubai to be aware of these conditions.

It’s a vicious cycle: Poor nutrition can encourage the persistence of active tuberculosis disease, and active tuberculosis leads to worsening malnutrition. So to keep your body primed to fight TB, you have to feed it right.

So here are some diet tips to fight tuberculosis,

*Good quality protein in the diet protein makes the immunity cells strong as it’s a building block of the body. Protein deficiency may have a particularly detrimental effect on the ability of the body to fight tuberculosis. Choose dairy, lean meats, pulses, beans. Eat 2-3 portions daily.

*Daily include at least a source of an antioxidant from colored fruits and vegetables which boost your immune power.

*Include dark green leafy vegetables twice a day to enrich your meal with iron content.

* Keep fibers in your diet in the form of whole-grain cereals, pulses, and germinated legumes which helps to keep the gut healthy and removes bad toxins, bad fat from the diet.

* Choose a healthy form of fat which is unsaturated oil over saturated oil like olive oil, sunflower oil instead of butter or margarine.

* It particularly is important to avoid consuming any alcohol during the entire course of your treatment as this could result in treatment complications and side effects.

Role of micronutrients

Zinc

Various studies on patients with tuberculosis had shown significantly lower plasma zinc levels than those without tuberculosis, irrespective of their nutritional status. An adequate supply of zinc may also limit free radical membrane damage during inflammation.

Your diet should include nuts, beans, fish, lean meat, mushroom, spinach.

Vitamin A

It has been shown that vitamin A has an immunocompetent role in human tuberculosis. Vitamin A was reported to inhibit the multiplication of virulent bacilli in cultured human macrophages.

Vitamin A is essential for the normal functioning of T and B lymphocytes, macrophage activity, and generation of antibody response

Red and orange-colored fruits and vegetables should be included on daily basis.

Vitamin D

Vitamin D plays a role in the function of macrophages, and a key factor in host resistance in tuberculosis.

Vit D fortified food includes eggs, fish like tuna, mackerel.

Selenium

The essential trace element selenium has an important function in maintaining the immune processes and thus may have a critical role in the clearance of mycobacteria. Selenium has been found as a significant factor in the relative risk for developing mycobacterial diseases in HIV-positive patients.

Nuts and nut seeds in a moderate quantity should be taken twice a week.

Iron

There are two explanations for the association of low iron status and infection. One is that anemia results from chronic infection and the other is that iron deficiency would increase susceptibility to infection such as tuberculosis.

Green leafy vegetables with a piece of lemon are a healthy tip to enhance iron absorption in the body.

Polyunsaturated fatty acids

In a research study, It was concluded that supplementing the diet with (n-3-) fatty acids can affect resistance to M. tuberculosis, whereas supplementing with (n-6-) fatty acids does not.

A combination of olive oil, nuts, and cooking oil like sunflower, cottonseed oil, rice bran oil is best.

Ms. Sushma Ghag

Dietician

Aster Hospital

The Right Diet to Beat Tuberculosis – Tuberculosis Center

Getting Good Nutrition When You Have TB

To give your body the vitamins, minerals, and other nutrients it needs to fight active tuberculosis and regain your strength and stamina, you need to eat a diet containing a variety of healthy foods, such as:

• Leafy, dark-colored greens like kale and spinach, for their high iron and B-vitamin content
• Plenty of whole grains, like whole wheat pastas, breads, and cereals
• Antioxidant-rich, brightly-colored vegetables, such as carrots, peppers, and squash, and fruits, like tomatoes, blueberries, and cherries — think of buying produce in a full rainbow of colors
• Unsaturated fats like vegetable or olive oil, instead of butter

Talk to your doctor about whether you have any nutrient deficiencies and if taking a daily multivitamin with minerals makes good nutrition sense for you. A recent review of the limited studies done on supplements in patients with TB showed some evidence that high-calorie energy supplements helped underweight patients gain body weight, and that zinc, combined with other micronutrients or with vitamin A, may offer nutritional help. The reviewers concluded that additional studies are needed.

What to Avoid When You Have Active Tuberculosis

As is always the case for good health, there are certain foods you shouldn’t eat and substances you shouldn’t use.

• Skip tobacco in all forms.
• Don’t drink alcohol — it can add to the risk of liver damage from some of the drugs used to treat your TB.
• Limit coffee and other caffeinated drinks.
• Limit refined products, like sugar, white breads, and white rice.
• Avoid high-fat, high-cholesterol red meat and instead load up on leaner protein sources like poultry, beans, tofu, and fish.

Getting and Staying Healthy With Active TB

Many medications used to treat active tuberculosis have side effects that can make it difficult to eat well. With some drugs, you could:

• Lose your appetite
• Feel nauseated
• Vomit
• Experience abdominal cramping

You can’t stop taking your TB drugs, so instead talk to your doctor about what you can do to help eliminate side effects.

Make every effort to give your body the nutrition it needs to maintain a healthy weight and build up strength to destroy the tuberculosis bacteria and reduce your risk of a relapse. Eating a varied, healthy diet, and staying away from unhealthy habits, will help you feel better, faster.

Could You Have TB and Not Know It?

You might think you’d know if you had a disease as serious as tuberculosis (TB), but that’s not necessarily the case.

Nearly one third of the world’s population — about 2.3 billion people — is infected with TB, according to the Centers for Disease Control and Prevention (CDC), but many may not know it. In fact, the vast majority of people infected with TB will never get sick — they won’t experience symptoms or become infectious. It’s a condition known as latent tuberculosis, in which the bacteria that cause TB simply stay dormant in the body.

In about 5 to 10 percent of people infected with TB, the bacteria will become active. People with active TB will experience symptoms and can spread TB to others. Nearly 1.5 million people die from TB every year, usually in underdeveloped countries, according to the CDC.

Understanding Tuberculosis

TB is caused by a type of bacteria called Mycobacterium tuberculosis, which can travel in droplets or mucus emitted in the air when a person with active TB coughs, sneezes, speaks, or sings. People nearby who breathe in the bacteria can become infected. TB is usually spread only with very close contact, commonly between family members, but sometimes among the co-workers and healthcare providers taking care of an infected person.

In addition to being in contact with a person who has active TB, other risk factors for TB infection include:

• HIV infection, diabetes, certain cancers, and other conditions that weaken the immune system
• Traveling to, living in, or immigrating from areas of the world with high rates of TB, including Latin America, Africa, Asia, and Russia
• Living or working in a location where TB is more common, including prisons, homeless shelters, immigration centers, nursing homes, and healthcare facilities
• Substance abuse

RELATED: Preventing the Spread of Tuberculosis Infection

Having the infection but not active disease is called latent TB. With latent TB, the bacteria resides in the body as though it’s sleeping, explains Eric Rubin, MD, PhD, a professor of immunology and infectious diseases at the Harvard School of Public Health. However, the bacteria can be reactivated, or awakened. In that case, the infected person develops active TB, which causes symptoms and causes the person to become contagious. Active TB is more likely to develop in people who became infected within the past two years.

In active TB the bacteria multiply in the body and usually attack lung tissue, though they can also damage the kidneys, spine, and brain. Symptoms of TB include a bad cough that lasts three weeks or longer, chest pain, a cough that brings up blood or sputum (a mix of saliva and mucus), chills, fever, and night sweats.

The only way to know if you’ve been infected with TB is to get a skin or blood test.

The Risks of Latent Tuberculosis

Latent TB poses special risks for people with weakened immune systems. That’s because an immune system that’s compromised — whether because of another disease, such as HIV or diabetes, or from drug or alcohol abuse — may not be able to fight off the bacteria, making it more likely that active TB will develop.

The elderly and infants are also more likely to develop active disease if they become infected with TB because their immune systems aren’t as strong as those of healthy adults.

The CDC recommends that people who test positive for TB after exposure receive treatment with a long-term course of antibiotics to reduce the chance of developing the active disease. Active disease itself must be treated aggressively. Without the right treatment, TB can be fatal.

But just how serious a risk is TB for Americans? The CDC’s most recent statistics show 9,421 cases in the country in 2014, the lowest number since national tracking began in 1953.

“It’s associated primarily with immigrants, because they were exposed in their home countries,” Rubin says. According to the CDC, two-thirds of the reported TB cases in 2014 were among people born abroad.

“There is not much TB transmission in this country, so there is not a lot of latent disease,” he says. “In our grandparents’ generation, it was common, in our parents’, it was less common, and it’s very uncommon now.”

Food & TB – diet for a person with TB

There is no special food that is required by a person with TB. A person with TB does not need special food, although they they should try and have a balanced diet.

Some people with TB also believe that more expensive foods are better than less expensive ones. This is not true. For example, it is not true that costlier varieties of rice are better than cheaper ones.

It is often better that a person with TB has the same diet as normal but possibly with some changes being made to increase their intake of food. People with TB often have a poor appetite initially, but having more frequent food intake can be helpful.

Within a few weeks of starting TB treatment, the person’s appetite should increase and come back to normal. A person with TB should aim to have three meals and three snacks each day to increase the amount of food they eat.

A healthy balanced diet for a person with TB

A person with TB should aim to have a healthy balanced diet. A healthy balanced diet can be achieved by having foods from four basic food groups. These are:

• Cereals, millets and pulses
• Vegetables and fruits
• Milk and milk products, meat, eggs & fish
• Oils, fats and nuts and oils seeds.

A food group is a collection of foods that share similar nutritional properties. If the food eaten contains food from all the above food groups, then the diet is considered healthy. Not all the food groups need to be eaten at every meal.

Types of food, essential nutrients

An essential nutrient is a nutrient that must be provided by a person’s diet. These nutrients are necessary for the body to function properly. The six essential nutrients include carbohydrates, protein, fat, vitamins, minerals & water.

Attempts should be made to increase the energy and protein content of the food in meals and snacks without increasing its volume. So, for example, addition of oil or butter to chapatti or rice can increase the energy content of the diet. A person with TB should also be encouraged to eat pulses in other forms e.g. roasted chana.

People with TB need a variety of foods from different groups

Oils & fats are a source of energy. In terms of oil, soyabean oil, mustard oil and coconut oil, are all acceptable. Nuts like ground nuts are good sources of energy and protein and can be taken as snacks in either fried or roasted form. Ground nuts are equivalent in nutritional terms to more expensive nuts like almonds, cashews.

Proteins can be of animal origin like milk, eggs, meat and fish or of plant origin as in cereals & pulses. For vegetarians, a combination of cereals & pulses can give a quantity of protein equivalent to that of animal proteins. The daily consumption of milk and milk products is also beneficial. In the case of non vegetarians, consumption of eggs on a daily basis can provide the same benefit as meat and fish at a lower cost.

Vegetables, especially leafy vegetables and fruits are vital sources of vitamins & minerals and should be part of the daily diet. Locally available fruits are as good as more expensive fruits transported over long distances.

TB & Nutrition

Nutrition means looking at the nutrients that are provided by people’s diets. For a long time it has been known that there is a link between TB & malnutrition. If people do not have sufficient nutrition, sometimes referred to as under nutrition, then this makes TB worse.  Under nutrition weakens the body’s ability to fight disease.

TB also makes under nutrition worse. Most individuals with TB experience weight loss. This can be caused by several factors including reduced food intake due to loss of appetite.

In India a Direct Benefit Transfer scheme provides people with TB with additional money for food.

Physical activity

If a person with TB is able to carry out any physical activity then this can be beneficial. Physical activity helps food intake to be converted into muscle mass, and it also improves the appetite.

What food should be avoided by a person with  TB

A person with TB should avoid the following:

• Alcohol in any form, as it increases the risk of drug toxicity
• Carbonated drinks
• Excess of tea and coffee, or their intake with food
• Tobacco and tobacco products
• An excess of spices & salt.

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Tuberculosis and nutrition

Abstract

Malnutrition and tuberculosis are both problems of considerable magnitude in most of the underdeveloped regions of the world. These two problems tend to interact with each other. Tuberculosis mortality rates in different economic groups in a community tend to vary inversely with their economic levels. Similarly, nutritional status is significantly lower in patients with active tuberculosis compared with healthy controls. Malnutrition can lead to secondary immunodeficiency that increases the host’s susceptibility to infection. In patients with tuberculosis, it leads to reduction in appetite, nutrient malabsorption, micronutrient malabsorption, and altered metabolism leading to wasting. Both, protein-energy malnutrition and micronutrients deficiencies increase the risk of tuberculosis. It has been found that malnourished tuberculosis patients have delayed recovery and higher mortality rates than well-nourished patients. Nutritional status of patients improves during tuberculosis chemotherapy. High prevalence of human immunodeficiency (HIV) infection in the underdeveloped countries further aggravates the problem of malnutrition and tuberculosis. Effect of malnutrition on childhood tuberculosis and tuberculin skin test are other important considerations. Nutritional supplementation may represent a novel approach for fast recovery in tuberculosis patients. In addition, raising nutritional status of population may prove to be an effective measure to control tuberculosis in underdeveloped areas of world.

Keywords: Antituberculosis chemotherapy, human immunodeficiency virus (HIV) infection, malnutrition, micronutrients, tuberculosis

INTRODUCTION

Malnutrition and tuberculosis are both problems of considerable magnitude in most of the underdeveloped regions of the world. It is important to consider, how these two problems tend to interact with each other. The term consumption has been virtually synonymous with tuberculosis throughout the history¹ and the link between tuberculosis and malnutrition has long been recognized; malnutrition may predispose people to the development of clinical disease and tuberculosis can contribute to malnutrition.² Before the advent of antituberculosis chemotherapy, a diet rich in calories, proteins, fats, minerals, and vitamins was generally considered to be an important, if not essential factor in treatment of tuberculosis. The introduction of specific antituberculosis drugs, however, has so radically altered the management of the disease that the role of diet should be considered in the light of the advances in treatment.

In the 21^st century, tuberculosis is still the most frequent underlying cause of wasting worldwide. However, pathophysiology of wasting in tuberculosis remains poorly understood.³ The prevalence of widespread malnutrition in the population may be expected to pose some special problems with regard to the control of the tuberculosis in the developing countries from the larger point of view of prevention and therapeutic management of individual cases, from the narrower clinical point of view.

The direct evidence of effect of nutrition on tuberculosis is difficult because of whole complex of coincident environmental factors. Despite these limitations, the weight of evidence still favors the view that malnutrition may be an important factor in the high mortality and morbidity from tuberculosis in population subjected to food shortage. ⁴ In any consideration of the role of nutrition in tuberculosis, three important questions arise.⁴ Does malnutrition predispose to tuberculosis infection? Does malnutrition influence or modify the course of established tuberculosis infection? Do nutritional factors influence the response to chemotherapy?

High prevalence of human immunodeficiency (HIV) infection in the underdeveloped countries further aggravates the problem of malnutrition and tuberculosis. HIV infection is an important risk factor for development of tuberculosis and adversely affects the nutritional status of patient.

EFFECTS OF MALNUTRITION ON TUBERCULOSIS

There are several experimental, clinical, and epidemiological studies demonstrating the effects of malnutrition on tuberculosis.

Epidemiological studies

It has been pointed out that tuberculosis mortality rates in different economic groups in a community tend to vary inversely with their economic levels. There are also numerous observations pointing to increase in tuberculosis mortality in various countries during times of war and famine. ⁵

There are numerous studies dealing with the effects of different diets on tuberculosis patients, and widely divergent and contradictory claims have been made. Difficulty in interpretation of these studies is influence of other factors on infection. Among tuberculin skin test positive U.S. navy recruits, the risk of tuberculosis was nearly four-fold higher among men who were at least 10% underweight at baseline than in men who were at least 10% overweight.⁶ In a study among 1,717,655 Norwegians, >15-years old who were followed for 8–19 years after intake into a radiographic screening program, the relative risk of tuberculosis among persons in the lowest body mass index (BMI) category was more than five-fold higher than the group in the highest BMI category, and it was independent of sex, age, and radiographic findings.⁷

In another study conducted in London, it was found that Hindu Asians had an increased risk of tuberculosis compared with Muslims. Religion had no independent influence after adjustment for vegetarianism (common among Hindu Asians).⁸ There was a trend of increasing risk of tuberculosis with decreasing frequency of meat or fish consumption. Lacto-vegetarians had an 8.5-fold risk compared with daily meat/fish eaters. Decreased immunocompetence associated with a vegetarian diet may result in increased mycobacterial reactivation.

Poor nutrition among patients who have undergone gastrectomy may be a risk factor for the reactivation of tuberculosis. There are other studies indicating that incidence of tuberculosis is unusually high among malnourished people.⁹

Now it is important to consider how malnutrition can increase risk of tuberculosis. The host protective immune mechanism of infection with Mycobacterium tuberculosis depends critically on the interaction and cooperation between monocyte-macrophages and T-lymphocytes and their cytokines.¹⁰ Substantial experimental evidence suggests that malnutrition can lead to secondary immunodeficiency that increases the host’s susceptibility to infection. Increased risk of tuberculosis can result from alteration in the individual protective function of, or the interaction between T-lymphocytes and macrophages because of nutritional insult.¹¹

The reactivation of latent or previously subclinical tuberculosis infection may be related, in part, to deteriorating nutritional status.¹² Protein malnutrition has been identified as an important risk factor for the predisposition to intracellular infection leading to death.¹³

Animal studies

Though there are several studies on experimental animals that have concluded contributory role of malnutrition on tuberculosis, an important snag in the interpretation of experimental data is the question as to how far these data obtained in the experimental animals are really applicable to human subjects. The natural history and evolution of tuberculosis in the animals and human beings need not necessarily be the same, and of course, the nutritional requirements of the animals and human subjects are also different. ⁵

It was reported that protein calorie malnutrition markedly enhanced bacterial growth and dissemination in mice resulting in rapidly fatal tuberculosis infection and a markedly elevated bacillary load in the lungs of protein deficient mice.¹¹

Study on guinea pigs demonstrated that protein malnutrition impairs the protective interaction between macrophages and T-lymphocytes and/or the acquisition of mycobactericidal and mycobacteriostatic activity by macrophages in the presence of adequate activation signals.¹⁴ Protein deficiency prevented guinea pigs from generating a population of antigen-specific-immune lymphocytes and/or impaired the proliferation capacity of these cells.¹⁵

Cytokines play a central role in mediating antimycobacterial immunity. Interleukin-2 (IL-2) is required to initiate and amplify immune responses. IL-2 production was depressed in chronic protein deficient guinea pigs vaccinated with M bovis BCG. ¹⁶ Result of a study on guinea pigs demonstrated that protein malnutrition potentiates the M. tuberculosis h47Rv-infected macrophages-monocytes to produce higher levels of transforming growth factor-β (TGF-β) which is a likely mediator of immunosuppression and immunopathogenesis in tuberculosis.¹⁴

In nutshell, it can be said that malnutrition exerts detrimental effects on many aspects of host immune responses against mycobacterial infection. First, dietary deficiency causes thymic atrophy and impairs the generation and maturation of T-lymphocytes in animal models of tuberculosis, resulting in reduced number of immunocompetent T-cells in lymphoid compartments including the blood. Second, deficiency of protein and other nutrients impair T-cell functions, including decreased production of Th₁CK IL-2 and IFN-γ and depressed tuberculin reaction and PPD-induced lymphoproliferation in guinea pigs and mice infected with virulent M. tuberculosis. Third, protein malnutrition impairs sequestration or trapping of reactive T-lymphocytes and loss of tuberculosis resistance following BCG vaccination. Finally, protein malnutrition potentiates M tuberculosis h47Rv infected monocytes-macrophages to produce higher level of TGF-β-a cytokine which has been implicated as a likely mediator of immunosuppression and immunopathogenesis in tuberculosis.

There are some studies which do not prove the role of malnutrition in tuberculosis. A four-year follow-up of treated cases of pulmonary tuberculosis in a study at the Madras Tuberculosis Chemotherapy Center showed that about 90% of patients maintained quiescence throughout the four-years period follow-up in spite of the fact that they were living under great stress of socioeconomic conditions including poor diet. Furthermore, the few patients who had a bacteriological relapse were at no special dietary disadvantage in comparison with those who had quiescent disease throughout.⁴

EFFECTS OF TUBERCULOSIS ON NUTRITIONAL STATUS

Nutritional status is significantly lower in patients with active pulmonary tuberculosis compared with healthy controls in different studies in Indonesia, England, India, and Japan. ¹⁷ Tuberculosis patients have been found to have lower serum albumin concentration than controls.¹⁷ Tuberculosis is probably associated with more severe malnutrition than other chronic illnessess; in an Indian study, the nutritional status of patients with tuberculosis was worse than that of those with leprosy. A study in Uganda demonstrated that poor nutritional status is common among adults with pulmonary tuberculosis.¹⁸ In yet another Indian study, tuberculosis patients were respectively 11 and 7 times more likely to have a BMI < 18.5 and mid-arm circumference < 24 cm.¹⁹

For any infection, there is a complex interaction between the host response and the virulence of the organisms, which modulates the overall metabolic response and the degree and the pattern of tissue loss. In patients with tuberculosis, a reduction in appetite, nutrient malabsorption, micronutrient malabsorption, and altered metabolism leads to wasting.^20,21

In a study, Indian patients with pulmonary tuberculosis were compared with malnourished and normally nourished healthy subjects. Whereas protein synthesis and breakdown in the fasting state were not significantly different between groups, patients with tuberculosis used a larger proportion of proteins from oral feeding for oxidation and hence for energy production than did either control group. Such failure to channel food protein into endogenous protein synthesis has been termed “Anabolic block”. This anabolic block represents one of the mechanisms for wasting in tuberculosis and other inflammatory status.^21,22

Anorexia is also a contributing factor for wasting in tuberculosis. In an unselected U.S. cohort of patients diagnosed with tuberculosis, 45% lost weight and 20% had anorexia.²³ Increased production of cytokines with lipolytic and proteolytic activity cause increased energy expenditure in tuberculosis.²⁴ Leptin may also play an important role in wasting.²⁵ In a study, malnutrition has been associated with atypical presentations of tuberculosis. ²⁶

Role of micronutrients

Because of diverse metabolic characteristics and functions, micronutrients have presently been accepted as essential for optimum human health. Micronutrients deficiency is considered to be the most frequent cause of secondary immunodeficiency and infection related morbidity including tuberculosis.

Zinc

Zinc deficiency affects the host defenses in a variety of ways. It results in decreased phagocytosis and leads to a reduced number of circulating T-cells and reduced tuberculin reactivity, at least in animals.¹⁷In vitro cellular killing by macrophages was found to be reduced during zinc deficiency and rapidly restored after zinc supplementation.²⁷

Various studies on patients with tuberculosis had shown significantly lower plasma zinc level than those without tuberculosis, irrespective of their nutritional status. There was significant rise in zinc level at the end of six- months of antituberculosis therapy (ATT). Thus, it may be suggested that plasma zinc status is likely a marker for monitoring the severity of disease and response to therapy.^17,28,29 Zinc deficiency in tuberculosis is likely due to redistribution of zinc from plasma to other tissues or reduction of the hepatic production of the zinc carrier protein α2-macroglobulin and to a rise in the production of metallothionein, a protein that transports zinc to the liver.¹⁷

Reduction in plasma zinc concentration was shown in tuberculosis patients after two months of treatment. This phenomenon may be because during the intensive phase of ATT, the antituberculosis drugs were used to kill the population of replicating bacilli and zinc may play important role in the macrophage contribution to host defenses at the site of infection.³⁰ The other possible mechanisms could be the effect of antituberculosis drugs on zinc absorption. Ethambutol was shown in rats to increase not only zinc absorption but also urinary zinc losses, resulting in reduced circulating zinc concentration. ³¹

Zinc supplementation of patients with pulmonary tuberculosis and bacterial pneumonia was shown to increase immune function.³² In a study, it was found that PPD indurations were larger in children receiving zinc and zinc increases the PPD induration size in children irrespective of nutritional status.³³

Zinc has essential role in vitamin A metabolism. Studies in humans and animals have shown that zinc deficiency impairs the synthesis of retinal binding proteins and reduces plasma retinal concentration.³⁴ Therefore, it appears that zinc supplementation has a beneficial effect on vitamin A metabolism which has important role in tuberculosis. An adequate supply of zinc may also limit free radical membrane damage during inflammation.³⁵

Vitamin A

It has been shown that vitamin A has immunocompetent role in human tuberculosis. Vitamin A was reported to inhibit multiplication of virulent bacilli in cultured human macrophages. ³⁶ In addition, vitamin A has a vital role in lymphocyte proliferation and in maintaining the function of epithelial tissues.³⁷ Vitamin A is essential for normal functioning of T and B lymphocytes, macrophage activity, and generation of antibody response.³⁸

A study from Rwanda reported vitamin A deficiency among adults with tuberculosis. Concentration of vitamin A was found to be lower in tuberculosis patients than that in controls in many studies.^39,40 The low concentration of retinal in plasma can be due to number of factors including reduced intake or reduced absorption of fat. Additionally, infection itself can compromise vitamin A status in number of ways.⁴¹ Vitamin A is excreted in the urine in patients with fever and this has been confirmed in subjects with acute infection including pneumonia.⁴² During the acute phase response, leakage of proalbumin through the vascular endothelium occurs; and production of retinal binding proteins and prealbumin by liver is reduced. ⁴¹ In addition, requirement of vitamin A during infection is raised by its increased rate of excretion and metabolism.⁴²

In an Indian study, the low vitamin A levels observed in tuberculosis patients returned to normal at the end of ATT without vitamin A supplementation.⁴³ Vitamin A deficiency increases bacterial adherence to respiratory epithelial cells.⁴⁴

In the prechemotherapeutic era, cod liver oil rich in vitamin A and D was used regularly to strengthen host defence.⁴⁵ Supplementation of vitamin A appears to increase survival among chicks infected with M. tuberculosis and enhances both T-lymphocyte and antibody responses to M. tuberculosis.⁴⁶

Vitamin D

Vitamin D plays a role in the function of macrophages, key factor in host resistance in tuberculosis. Abnormalities in vitamin D status have been reported in tuberculosis. Genetic variations in the vitamin D receptor were identified as a major determinant of the risk for tuberculosis in Africans. ⁴⁷ Vitamin D deficiency itself was shown to be a risk factor for tuberculosis.⁴⁸ Adults with untreated tuberculosis in Indonesia were shown to have significantly lower 25-hydroxy-vitamin D compared with controls.⁴⁹

Studies have yielded inconsistent findings regarding serum or plasma calcium concentration during tuberculosis. A study in Africa has related hypocalcemia to moderate to extensive radiographic disease.⁵⁰

Vitamin E

In many studies, concentration of vitamin E was found to be significantly lower in tuberculosis patients than healthy controls.^39,51

Vitamin C

Studies have linked vitamin C deficiency with tuberculosis.^39,51 In Ethiopians, concentrations of antioxidant vitamin C, vitamin E, and vitamin A were significantly lower in tuberculosis patients and high malonaldehyde concentration was associated with clinical severity.⁵²

Selenium

The essential trace element selenium has an important function in maintaining the immune processes and thus may have a critical role in clearance of mycobacteria. Selenium has been found as significant factor in the relative risk for developing mycobacterial diseases in HIV positive patients.⁵³

A recent Indian study measured concentrations of circulating antioxidants and markers of oxidative stress in tuberculosis patients. Results showed lower antioxidant potential (lower levels of superoxide dismutase, catalase, glutathione, and ascorbic acid) and enhanced lipid peroxidation products (malonaldehyde) in tuberculosis patients. Antioxidant potential increased with treatment.⁵⁴

Iron

Anemia is highly prevalent among adults with pulmonary tuberculosis.¹⁷ In a study conducted in Ghana, 50% adults with pulmonary tuberculosis had significantly lower hemoglobin than healthy matched controls. Iron deficiency may also be a contributing factor.⁵⁵

In a study, concentration of hemoglobin was lower in tuberculosis patients than that in controls¹⁷ and those of zinc protoporphyrin (ZPP) were significantly higher than in controls. Elevated concentration of ZPP, a measure of free erythrocyte porphyrin, is indicative of iron deficient erythropoiesis.⁵⁶

There are two explanations for the association of low iron status and infection. One is that anemia results from chronic infection and the other is that iron deficiency would increase susceptibility to infection such as tuberculosis.¹⁷

Copper

In a recent study, compared with the control group, the concentrations of iron, zinc, and selenium were significantly lower while that of copper and copper/zinc ratio were significantly higher in the serum of tuberculosis patients.⁵⁷ The serum concentration of zinc increased and serum copper concentration and copper/zinc ratio decreased significantly after antituberculosis chemotherapy.

Polyunsaturated fatty acids

In a study, eicosanoid synthesis was studied in macrophages of guinea pigs fed with different amounts of omega-6 fatty acids and omega-3 fatty acids. It was concluded that supplementing the diet with (n-3-) fatty acids can affect resistance to M. tuberculosis, whereas supplementing with (n-6-) fatty acids does not.⁵⁸

Cholesterol

Hypocholesterolemia is common among tuberculosis patients and is associated with mortality in miliary tuberculosis cases. In vitro studies concluded that cholesterol-rich diet accelerated the sterilization rate of sputum culture in pulmonary tuberculosis patients suggesting that cholesterol should be used as a complementary measure in ATT.⁵⁹

HUMAN IMMUNODEFICIENCY VIRUS INFECTION

Tuberculosis and Human imunodeficiency virus (HIV) infection are wasting diseases that frequently occur together. Two studies in Haiti and England showed significant difference between arm muscle circumference in adults with tuberculosis and healthy controls.⁶⁰ Mid-upper arm circumference was significantly lower among HIV positive adults with tuberculosis than in HIV negative adults with tuberculosis.²⁶ Mean triceps skin fold thickness is also lower in HIV positive adults with tuberculosis than in HIV negative adults with tuberculosis.⁶⁰

One study demonstrated that there appears to be a relationship among BMI, host immune function, and natural history of HIV in adults with tuberculosis.⁶¹ Overexpression of TNF-α may be the cause of wasting.

Net protein anabolism is impaired in patients with HIV positive adults with tuberculosis infection and this impairment is significantly more than that seen in patients with HIV or tuberculosis infection alone. Mortality is increased in HIV and tuberculosis patients who have significant wasting.

In malnourished tuberculosis patients, combination of enhanced oxidative stress and decreased concentration of several antioxidants may have important pathogenic consequences in HIV infected tuberculosis patients. Oxidative stress has been shown to enhance HIV replication, to induce the production of several inflammatory cytokines and to promote lymphocytic apoptosis^62,63 and T-cell dysfunction; and could therefore contribute to increased viral replication and progression of immunodeficiency in patients dually infected with HIV and tuberculosis.⁶⁴

Nutritional needs of children with tuberculosis

The rapid growth periods of infancy and childhood can only be maintained if a child’s nutrient intake is optimal. Tuberculosis can cause impaired growth and malnutrition. Provision of adequate energy and nutrients for a child with tuberculosis is very important since the child has increased requirements as a result of both growth and tuberculosis.

Various studies have concluded that all children presenting with malnutrition or failure to thrive must be evaluated for possible tuberculosis. Because children have limited stomach capacity and appetite, meeting nutritional requirement in children presents a difficult challenge.⁵

Drug nutrient interaction

Concomitant feeding and administration of antituberculosis drugs with food has been shown to result in decreased bioavailability of rifampicin and isoniazid.⁶⁵

Ethambutol has been shown in rats to increase not only zinc absorption but also urinary zinc losses, resulting in reduced circulating zinc concentration.³¹

Peripheral neuropathy is a well-known adverse effect of isoniazid. Though this is reported to be rare in patients receiving dosages of isoniazid of the order of 5 mg/kg, it is frequently found in subjects receiving higher doses.⁴ Isoniazid-induced peripheral neuropathy is frequently observed among poor segments of population because of malnutrition.

Finally, adverse reactions of antituberculosis drugs are risk factors for malnutrition, independent of age, gender, education, occupation, and access to food stuffs.⁶⁶

NUTRITIONAL STATUS AND CLINICAL OUTCOMES

Nutritional status appears to be an important determinant of clinical outcome during tuberculosis. In an Indian study, 163 patients with tuberculosis were treated either in a sanatorium with a well-balanced diet or at home on a markedly poor diet. The overall treatment response was similar in both groups, however, those receiving better nutrition tended to show more rapid clearance of bacteria and radiographic changes in addition to greater weight gain.⁶⁷

Experimental studies on rats have shown that animals on high protein diet recovered from the negative nitrogen balance phase following an infection more rapidly than those on low protein diet.⁵ Clinical studies have shown that prognosis in case of tuberculosis is decidedly more favorable in subjects with positive nitrogen balance than in those with negative nitrogen balance.⁵

Serum albumin and hemoglobin concentrations have been found as strong predictors of survival in adults with pulmonary tuberculosis.⁶⁸ In another study on tuberculosis patients, albumin, cholesterol, cholinesterase, hemoglobin level, and weight were lower in patients who died than in those who survived.⁶⁹ In a study in Malawi among 1181 patients with tuberculosis, the risk factor for early mortality included age >35 years, HIV seropositivity, and a high degree of malnutrition.⁷⁰ Among adults with moderate to severe malnutrition, 10.9% died in the first four weeks of treatment as opposed to a 6.5% death rate in adults who were normal or had mild malnutrition. Finally, wasting in tuberculosis is associated with impaired physical function.

Changes in nutritional status during chemotherapy

Studies have shown that nutritional indicators such as anthropometric measurements improve during tuberculosis chemotherapy.⁶⁷ A study conducted in Malawi showed that among 1181 adults with tuberculosis, weight significantly increased after four weeks of treatment, especially in HIV group.

Nutritional treatment of tuberculosis

Nutritional supplementation may help to improve outcome in tuberculosis patients. A study found that nutritional counseling to increase energy intake combined with provision of supplements, when started during the initial phase of tuberculosis treatment, produced a significant increase in body weight, total lean mass, and physical function after siix weeks. A large proportion (46%) of the early weight gain comprised lean tissue, confirming the findings that tuberculosis can mount a protein anabolic response on feeding. In the same study, patients in the nutritional supplementation group continued to show a greater increase in body weight than control subjects during later follow-up. However, the pattern changed toward deposition of predominantly fat mass, whereas in the control group, the weight gain comprised fat and lean tissue in approximately equal proportions.⁷¹ As described above, the changes in lean mass could be an underestimate of the actual improvement in nutritional status, given that feeding initially leads to a loss of extracellular water that accumulates in malnourished individuals, including those with tuberculosis.²⁰ Accelerating the recovery of lean tissue might help to restore physical functions more rapidly. Restoration of physical function might help to shorten the convalescent period and facilitate earlier return to productive work.⁷¹ Early restoration of nutrition could also lead to immunologic changes that could enhance the clearance of mycobacteria and reduce infectiousness of patient.

Vitamins and minerals can play important role in treatment of tuberculosis. In a trial among 110 new cases of active tuberculosis, subjects received tuberculosis chemotherapy alone, or in addition to injectable thiamin, vitamin B₆, and vitamin C, or an oral multivitamin supplement.⁷² All groups receiving any vitamin supplementation had significantly better lymphocyte proliferation responses than the group receiving no supplement. Another trial showed that vitamins C and E were effective in improving immune responses to tuberculosis when given as adjuvant to multidrug tuberculosis therapy.⁷³ The supplementation with vitamin A and zinc improved the effectiveness of the antituberculosis drugs in the first two months. The improved outcome was indicated by the higher number of patients with sputum negative for bacilli and significantly lower mean lesion area in the lungs.³⁰

A retrospective study on nonmiliary tuberculosis patients admitted in ICU with respiratory failure found that early and aggressive attention to improving the patient’s nutrition may be as important as effective ATT and mechanical ventilation in salvaging these patients.⁶⁸

Nutritional supplementation may represent a novel approach for fast recovery in tuberculosis patients. In addition, raising nutritional status of population may prove to be an effective measure to control tuberculosis in underdeveloped areas of world.

Foods that every TB patient should include in the diet

Tuberculosis is a fatal disease, and if not handled with proper care it worsens with time. TB is caused by bacteria called Mycobacterium tuberculosis and people with weak immunity are more prone to TB. In fact, tuberculosis is the second biggest killer, globally. Ample rest, medication and isolation for a while are required to deal with TB. It majorly affects the lungs, but it’s curable. TB patients have to be very careful when they go out and should wear a mask until they are fully recovered. So that can protect themselves from unwanted infections. 

The symptoms of TB include weight loss, weakness and shortness of breath. However, the consumption of certain foods can be beneficial for TB patients. These are some food items that people suffering from TB should include in their diet. 

Fruits:

Fruits rich in vitamin A, E, and C like orange, mango, papaya, guava, amla and lemon are a must. They should be included in the daily diet of a TB patient since these fruits are filled with nutrients. 

Milk:

Rich in calcium, milk acts as a magic food for TB patients. It’s not filled with proteins, but consumption of milk daily helps in bringing back the strength and immunity in a TB patient. For a quick recovery, TB patient should consume almond milk as it is light, easy to digest and full of vitamins.

Garlic:

Garlic can do wonders for TB patients. They should chew two or three buds of garlic every morning for a month, and it’ll help to eliminate the disease from the body. 

Green tea:

Minimize consumption of tea and coffee, and add green tea to your diet. Green tea is beneficial in the treatment of TB as it removes toxins from the body very quickly. 

Vegetables:

Veggies such as carrots, tomatoes, sweet potatoes, and broccoli are stuffed with pigments and antioxidants that are vital to get your health back on track.

Greens:

Inclusion of greens like spinach, fenugreek and kale are essential for TB patients since they are rich in iron and vitamin content. TB patient’s immunity and haemoglobin get very low due to the sickness, hence iron-rich food should be consumed daily.

Whole grains:

Whole grains like cereals, bread, etc. should be added to your diet when you have TB. These will not only help you satiate your hunger but will also lead to speedy recovery.

Apart from these food items, sunlight is a must for TB patient as there is a deficiency of vitamin D, so they should sit in the sun and take vitamin D containing foods.

Diet to help you fight Tuberculosis!

Tuberculosis or TB as it is widely known is a contagious bacterial infection that usually affects the lungs. It can spread to other parts of the body as well and is caused by a type of bacteria called Mycobacterium tuberculosis.

TB is a highly contagious disease, however, treatment is possible and there are high chances of recovery after long term administration of antibiotics. Just like the flu virus, TB infection can spread from an infected person to another through the air. When an infected person coughs, sneezes, talks, laughs, or sings, tiny droplets that contain the germs are released.  The infection spreads upon breathing in of these germs.

Diet to fight TB infection:

Timely diagnosis and long-term, on-time treatment through the use of a variety of TB drugs has been successful in completely curing the disease. Since the recovery time frame is quite long, the body becomes weak and this further increases the recovery period. To help your body fight off the infection, it is essential to provide the right nutrients to it.

Malnourished persons find it more difficult to fight off the TB infection and are also more susceptible for a relapse or reinfection after recovery. A simple high protein diet that is easy to digest along with enough vitamins and minerals to regain strength and stamina is effective in aiding recovery.

Here is a list of food items that should ideally be included in the daily diet:

1. Toned milk and curd

2. Hard boiled or poached eggs

3. Leafy dark colored greens like spinach and kale that are rich in Iron and B-complex

4. Whole grains like wheat and rice as carbohydrates aid in better digestion of proteins

5. Seasonal fruits and vegetables that are a rich source of natural vitamins and minerals

6. Use unsaturated fat like olive oil or vegetable oil

7. Drink plenty of water

A varied healthy diet and avoiding certain harmful substances like alcohol and tobacco as well as shunning refined food products and high-fat high cholesterol red meat products are beneficial in strengthening the body to fight off the tuberculosis infection.

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90,000 NUTRITIONAL NUTRITION FOR PATIENTS WITH TUBERCULOSIS “State budgetary institution of health care

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One of the basic principles of diet therapy for patients with tuberculosis is to provide an increased amount of protein in the diet, the increased breakdown of which is observed in this contingent of patients. During the period of exacerbation of the tuberculous process with pronounced tissue decay, significant inflammation, the protein content in the diet rises to 130 – 140 g / day. With progressive weight loss and insufficient calorie intake, an increased protein breakdown always occurs.The introduction of an increased amount of complete protein, the provision of sufficient calories, a properly selected composition help to achieve nitrogen balance. In patients with chronic tuberculosis who are on bed and ward rest, it is necessary to inject 1.5 – 2 g of protein per 1 kg of body weight. With an adequate amount of protein, oxidative processes are reduced.

During the period of attenuation of the process in tuberculosis of the lungs, bones, joints, lymph nodes, 110 – 120 g of protein are injected with food per day.Ensuring the optimal qualitative composition of protein (the ratio of essential and nonessential amino acids) in the diet is achieved by including proteins of both animal and plant origin in the diet, which increases their total biological value. Sources of protein in the diet of patients with tuberculosis are products of animal and plant origin, such as meat, fish, dairy products, eggs (egg white), cereals (buckwheat, oatmeal, pearl barley), cereals (with the inclusion of milk and soy protein), legumes (lentils). , beans, peas, soy products).

In the diet of tuberculosis patients, depending on the stage of the process, the nature of inflammation, concomitant diseases, an adequate fat content is provided, amounting to 80 – 120 g per day, of which at least 1/3 is vegetable fats. During the period of exacerbation of the tuberculous process, the total amount of fat rises to 110 – 120 g / day, during the period of attenuation of the process, it decreases to 80 – 90 g / day.

As sources of fat, both animal products (low-fat varieties of meat and poultry, river and sea fish, dairy products, butter) and vegetable oils (sunflower, corn) containing mainly omega-6 PUFA are used.The inclusion of sea fish (mackerel, halibut, capelin, etc.) in the diet ensures the enrichment of the diet with omega-3 PUFAs, as well as the use of biologically active food supplements in diet therapy that are sources of omega-3 PUFAs, which allows to optimize the fatty acid composition of the diet and thus reduces the risk of developing cardiovascular diseases in this contingent of patients.

The amount of carbohydrates in the diet of tuberculosis patients should be within the physiological norm (300 – 500 g / day) with a predominant content of complex slowly absorbed carbohydrates and controlled inclusion of rapidly absorbed refined sugars.With an exacerbation of the tuberculous process, body weight deficiency, the amount of carbohydrates in the diet is 400 – 500 g per day with a decrease in their content to 300 – 350 g / day during the period of attenuation of the process, as well as with concomitant disorders of carbohydrate metabolism (impaired glucose tolerance, diabetes mellitus ), allergization of the body (allergic diathesis, bronchial asthma, chronic eczema). A decrease in the amount of carbohydrates in the diet is provided mainly due to the exclusion of rapidly absorbed x refined sugars (sugar, honey, jam, syrups).

With an exacerbation of the tuberculous process, an increased excretion of mineral salts (calcium, potassium, phosphorus, sodium chloride) can be observed, therefore, in these cases, foods rich in minerals are included in the diet, the sources of which are milk, cheese, cottage cheese, eggs, figs, dried apricots, raisins, meat and fish products, nuts, etc.

When constructing therapeutic diets for patients with tuberculosis, it is necessary to take into account the adequate supply of the body with vitamins, the increased consumption of which is observed in this contingent of patients.Deficiency of bioantioxidanto B (vitamins C, E, Beta-carotene) promotes the activation of lipid peroxidation processes and potentiates the defects of cellular immunity in the tuberculous process. The introduction of a sufficient amount of ascorbic acid increases the bactericidal properties of blood, increases the formation of antibodies, and reduces intoxication. An increased need for vitamin C occurs in patients with fibro-cavernous hot tuberculosis during an exacerbation of the disease with pronounced tissue decay, significant inflammatory phenomena occurring with high fever and exhaustion.

Patients with tuberculosis of the lungs, larynx, intestines and skin need an increased amount of vitamin A to improve the regeneration of the epithelium. In case of osteoarticular tuberculosis, along with the provision in the diet of an increased amount of easily digestible proteins, calcium, phosphorus, the diet is enriched with vitamin D. and dietary (therapeutic and prophylactic ) foods enriched with vitamins, including antio vitamins xidants – A, E, C and Beta-carotene.

The main sources of ascorbic acid are fruits, berries, rose hips, vegetables; vitamin E – vegetable oils (soybean, corn, sunflower), nuts, seeds; vitamin A – milk fat, cheese, egg yolk; B vitamins – fresh vegetables, meat, bran dishes, brewer’s or baker’s yeast; vitamin D – caviar, sea fish, liver of fish and sea animals, chicken eggs. It is recommended to use foods rich in Beta-carotene in the diet – carrots, bell peppers, green onions, parsley, apples, citrus fruits.Correction of vitamin deficiency in patients with tuberculosis is also achieved by regular use of multivitamin preparations in recommended doses.

Considering that in chronic tuberculous intoxication, as a rule, the function of the digestive organs is disturbed with the development of concomitant diseases of the gastrointestinal tract th tract (peptic ulcer and duodenal ulcer, gastroduodenitis, intestinal dysbiosis, etc.), compliance with the principles of culinary processing food, the technology of preparing dietary meals, the correctness of the regimen and rhythm of nutrition are an important condition for increasing the effectiveness of diet therapy for patients with tuberculosis with concomitant diseases of the gastrointestinal tract.

The peculiarities of the technological processing of products and dishes is the removal of extractive substances, the use of boiling, baking and stewing as the main types of heat treatment. Frying, as a method of cooking food and dishes, has limited application in the diet therapy of tuberculosis patients. Vegetables (cabbage, radishes, tomatoes, cucumbers, lettuce, bell peppers, carrots, etc.), fruits, berries are recommended to be included in the diet mainly fresh.

It is necessary to observe a fractional diet, including 4 – 6 meals a day with an even distribution of all nutrients and calories throughout the day.

In patients with tuberculosis during the period of exacerbation of concomitant diseases of the digestive system, products with coarse vegetable fiber (white cabbage, turnip, radish, radish, sorrel, spinach, etc.) are excluded from the diet, vegetables and fruits are given in boiled, mashed, baked, stewed form , meat without fascia and tendons in a shabby or chopped form.

1.Planned number of beds in a 24-hour hospital (as of 25.08.2015)

2.Copy of the staffing table of the catering unit (Appendix 1)

3.Copy of the Regulation of the Council on Medical Nutrition (Appendix No. 2)

4. Copy of the Seven-Day Menu (Appendix No. 3)

5. Research at the food unit BGKP is carried out monthly, for 2015 the results are negative.

Research on nutritional value, microclimate, etc. according to the production control program are planned for the 3rd and 4th quarters of 2015, due to insufficient funding in the 1st half of the year.

6. Motor transport e means for delivering food to the departments are provided according to the contract.

7. Rooms for storing vegetables are available in sufficient quantity in accordance with sanitary and hygienic requirements .

8. Average daily set of products of the EVA diet (Appendix No. 4)

9. The equipment of the catering unit is on the balance sheet of the GBUZ OPTD.

Diet for tuberculosis

Tuberculosis is a predominantly chronic infectious disease in which the lungs are most often affected.Less common is tuberculosis of the kidneys, intestines, larynx, bones and joints, skin. For tuberculosis, changes in the affected organs are characteristic, including the decay of their tissues, and intoxication of the body. In tuberculosis, there are metabolic disorders and functions of various organs and systems, in particular, suppression of the function of the digestive system.

The most important part of the regimen of tuberculosis patients is nutritional therapy. By combining certain foods, prescribing special diets, it is possible to normalize the disturbed metabolism during the development of tuberculous inflammation, increase the reactivity of the body, and create favorable conditions for the development of reparative processes.

Curative nutrition for tuberculosis

A patient with tuberculosis needs a diet in which basic foods should be presented, containing not only the optimal amount of proteins, fats and carbohydrates, but also a sufficient amount of vitamins and mineral salts. It is not so much the amount of food and high calorie content that is important, but its quality composition.

The main thing in the treatment of newly diagnosed pulmonary tuberculosis or its exacerbation (relapse) are intensive regimens of taking 4-5 anti-tuberculosis drugs simultaneously for several months.Naturally, side effects from drugs can be expected with such chemotherapy. The final elimination of infection, resorption or delimitation of foci of tuberculous lesions of the lungs remain the task of the organism itself.

Hence the need to strengthen the body’s defenses, to overcome the side effects of anti-tuberculosis drugs, including through targeted nutrition.

General principles of diet therapy for tuberculosis:

• Provide the body with adequate nutrition in conditions of protein breakdown, deterioration of the metabolism of fats and carbohydrates, increased consumption of vitamins and minerals against the background of a frequent sharp decrease in appetite;
• increase the body’s defenses against infection and reduce the phenomena of intoxication;
• contribute to the normalization of impaired metabolism and eliminate secondary nutritional disorders of the body caused by the tuberculous process;
• to promote the restoration of tissues affected by tuberculosis infection.

The energy value of the diet depends on the characteristics of the course of tuberculosis, concomitant diseases, the patient’s body weight, as well as the nature of work with preserved working capacity. With an acute course or a sharp exacerbation of the disease and bed rest, 2200-2400 kcal per day is enough, with a semi-bed regime more – 2500-2700 kcal, with attenuation of the acute process or exacerbation of 2800-3100 kcal, or 40-45 kcal per 1 kg of body weight.

For patients with chronic pulmonary tuberculosis, especially young people, as well as with exhaustion, a diet is required, the energy value of which is 15-20% higher than physiological norms.The higher calorific value of the diet is not beneficial. Rapid and large gain in body weight can worsen the patient’s condition. It is a misconception that it is necessary to over-feed patients with tuberculosis, which leads to overfeeding and overloading of the digestive system.

In the diet, the protein content should be increased on average 90-100 g (1.3-1.4 g per 1 kg of normal body weight), and with exhaustion, sluggish course of the disease, tissue decay, attenuation of exacerbation 1.5-1.7 g of protein per 1 kg of normal body weight, on average 110-120 g, of which at least 55-60% is due to animal products.A high protein content is necessary to replenish its increased consumption, restore tissues in the focus of infection, and enhance the body’s defenses. In a severe course of the disease with high fever, severe intoxication, the amount of protein in the diet is limited to 70-80 g, of which 65% is due to the protein of animal products.

Taking into account the tastes of the patient, sources of protein can be various types of meat, poultry and fish, excluding very fatty ones. It is advisable to use dishes from the liver. In the chronic course of pulmonary tuberculosis, any culinary processing of these products is permissible.In the absence of contraindications (for example, with pleurisy with effusion), the diet includes meat and fish products – sausages, ham, herring, balyk, caviar, canned food (sprats, sardines, salmon in their own juice, etc.). The diet should include eggs and various dishes from them.

The full range uses dairy products with the obligatory inclusion of cottage cheese and cheese, as well as fermented milk drinks, including those enriched with probiotics and prebiotics (kefir, yoghurts, etc.).Taking probiotics not only normalizes the intestinal microflora, but also improves the course of tuberculosis. On the other hand, courses of kumis therapy against the background of resort climatotherapy have proven themselves well in the treatment of pulmonary tuberculosis.

If the patient wishes and there are no strict contraindications, alcoholic beverages can be used in small quantities (in terms of ethyl alcohol – up to 30 ml for men and 15-20 ml for women), especially grape wines, especially in order to improve appetite when it is often severely suppressed , which leads to a reduction in food intake.In the past, enotherapy (“wine therapy” using natural grape wines) was used in the treatment of pulmonary tuberculosis.

The fat content in the diet should not exceed 100-110 g, and with an exacerbation of the disease 70-80 g. The main sources of edible fats are butter and vegetable oils in their natural form, as well as soft (bulk) margarines. You should not overload the diet with fats, since this worsens the appetite reduced in tuberculosis, digestion is upset, and the products of incomplete oxidation of fats accumulate in the blood.The use of lard from badgers, marmots or bears is a long-standing folk remedy for tuberculosis, but the specific therapeutic effect of these fats has not been scientifically proven.

Carbohydrates replenish the energy value necessary for a particular patient, on average, their consumption should be within physiological norms: 350-400 g per day, of which 80-100 g – due to sugar, honey, jam and other sugary foods. Outside of the acute period of the disease, various flour products (pies and pies baked with meat or fish, biscuits, pastries, etc.) are included in the diet.), any dishes from different cereals (especially buckwheat and oatmeal), in particular, in combination with cottage cheese, pasta, well-boiled legumes. The necessary carbohydrate part of the diet is vegetables, fruits and berries in any culinary treatment, but with the obligatory inclusion of raw ones. Chronic pulmonary tuberculosis not in the exacerbation phase is included in the number of diseases in which ampelometry is used – treatment with grapes.

Particular attention in tuberculosis requires the provision of the body with vitamins, primarily B1 (thiamine), B6 ​​(pyridoxine) and C (ascorbic acid).This is due to the fact that, against the background of chemotherapy, the local formation of a number of vitamins by the microflora of the large intestine and the absorption of vitamins in the intestine are suppressed, as well as direct antagonism between anti-tuberculosis drugs and vitamin B6, between antibiotics and vitamin B1. Although the clinical picture of vitamin deficiency is rare, latent vitamin deficiency contributes to the toxic effect of chemotherapy drugs on the nervous system, liver, heart, skin and mucous membranes.

The standard of treatment for patients with pulmonary tuberculosis provides for the appointment of supplementing the diet with preparations of vitamin-mineral complexes.

The diet should provide an adequate supply of minerals, especially calcium, phosphorus and iron. Table salt is usually not limited, but sometimes its amount is increased to 20 g per day (with profuse sweating, diarrhea, vomiting) or limited to salt-free food (with fluid retention). Accordingly, the amount of free liquid in the diet changes: from the usual 1.5 liters to an increase (2-2.5 liters) or restriction (0.8-1 liters).

In uncomplicated tuberculosis, culinary processing of food is usual, eating 5-6 times a day.It is necessary to diversify food as much as possible, to exclude the frequent repetition of dishes in the menu. These requirements are mainly met by the considered approaches to nutrition, which are applicable for pulmonary tuberculosis during a period of moderate exacerbation or attenuation, for osteoarticular tuberculosis, and for tuberculosis of the lymph nodes.

In a hospital setting for tuberculosis, a high-protein diet 11 (t) is used.

The chemical composition of the therapeutic diet for tuberculosis

• 100-110 g of proteins, 60% of which are animals;
• 100-110 g fat, 20-25% of which are vegetable;
• 400-450 g carbohydrates;
• 12-15 g salt;
• 1.5 liters of liquid.

Therapeutic diet number 11 has an energy value equal to 2900-3100 calories.

Sample diet menu for the treatment of tuberculosis

1st breakfast: salad of fresh cabbage with apples and sour cream, an omelet of two eggs, oat milk porridge, tea, coffee or cocoa with milk.

2nd breakfast: a sandwich with cheese and butter, tomato or other juice.

Lunch: herring with vegetable oil and green onions, borscht in meat broth with sour cream, fried chicken with boiled rice, compote.

Afternoon snack: rosehip broth, cookies or pastries.

Dinner: meat zrazy stuffed with onions and eggs, mashed potatoes, buckwheat casserole with cottage cheese, tea with honey.

At night: fermented milk drinks.

90,000 Chapter 12 Therapeutic nutrition for tuberculosis

Chapter 12

Medical nutrition for tuberculosis

At the moment, tuberculosis remains one of the most widespread infectious diseases in the world, leading to high mortality.

The World Health Organization has declared tuberculosis a threatening medical and social problem. In the world, 8-10 million new cases of tuberculosis are registered annually, and about 3 million cases die.

Tuberculosis claims more lives than any other infection. It is believed that about two thirds of the world’s population is infected with mycobacterium tuberculosis. The disease develops mainly in people with a weakened immune system under unfavorable living conditions and a decrease in the body’s resistance.The main source of infectious agents (mycobacterium tuberculosis, less often African and bovine mycobacteria) is a person with tuberculosis, who releases mycobacteria into the environment. In most cases, tuberculosis is infected by airborne droplets, less often by airborne dust, alimentary.

Tuberculosis is a chronic infectious disease prone to recurrence, affecting most often the lungs, but damage to any other organ (mainly lymph nodes, urogenital, osteoarticular systems, skin, organs of vision) is possible.The emergence, course and outcome of tuberculosis are largely determined by the immune state of the organism, its reactivity, which determines the unusual variety of clinical and morphological manifestations of tuberculosis, which creates great difficulties in its clinical diagnosis.

It has been proven that under conditions of starvation and unbalanced nutrition, especially with insufficient content of proteins and vitamins in the diet, reactivation of tuberculosis often occurs .

Factors contributing to reactivation include various diseases, including: diabetes mellitus, lymphogranulomatosis, silicosis, gastric ulcer and duodenal ulcer, condition after gastric resection, chronic inflammatory lung disease, mental illness, chronic alcoholism, drug addiction, stress situations, AIDS, long-term use of corticosteroids and cytostatics.

Tuberculosis, as a serious infectious disease, is the cause of the rapid depletion of energy and plastic reserves of the patient’s body as a result of metabolic disorders, decreased or loss of appetite, nausea, vomiting, and digestive disorders. All of the above processes are aggravated by prolonged aggressive drug therapy, and if surgery is necessary, the processes of hypermetabolism and hypercatabolism are intensified even more. In this regard, patients with tuberculosis need active and long-term nutritional support, which should be carried out with the help of highly digestible high-energy and high-protein drugs.Traditional health-care diets made from natural products do not provide a balanced supply of nutrients for optimal digestion with reduced gastrointestinal function.

Causes of weight loss and progressive protein-energy malnutrition in patients with tuberculosis:

• insufficient food intake (unbalanced diet) due to lack of appetite, intoxication, anorexia, gastrointestinal tract dysfunctions;

• insufficient consumption of complete (animal) proteins, polyunsaturated fatty acids, vitamins, minerals, dietary fiber;

• peculiarities of the tuberculous process with a rapid depletion of the body’s energy and plastic reserves;

• concomitant disorders of the digestive, endocrine and other body systems;

• complications of tuberculosis chemotherapy (toxic-allergic reactions, gastrointestinal dysfunction, etc.)etc.).

Completely addressing malnutrition by using dietary diets alone is challenging. Traditional daily food packages (meat, fish, poultry, dairy products, cereals, etc.), which do not correspond to the energy requirements of tuberculosis patients, do not provide the required amount of macro- and micronutrients. At the same time, it is for patients with tuberculosis that it is of great importance to ensure a qualitative balance of diets, taking into account the peculiarities of the course of the tuberculosis process, the stage of the disease, and concomitant diseases.

In this situation, the only way to solve the problem of nutrition of patients with tuberculosis is to include in the program of therapeutic and prophylactic measures specialized products of medical nutrition, additional oral nutrition, and enteral tube feeding.

When constructing dietary rations for patients with tuberculosis, the following should be taken into account.

• Therapeutic nutrition for tuberculosis cannot be reduced only to enhanced nutrition – it must correspond to the nature and stage of development of the tuberculosis process and the state of the patient’s body.

• Power supply must be reinforced, but not redundant.

• Excessive content of fats and carbohydrates in the diet is accompanied by metabolic disorders – along with the accumulation and deposition of fat, there is a loss of muscle mass with a weakening of the muscular system, heart muscles, overloading the cardiovascular system.

• In patients with tuberculosis, oxidative processes are reduced, food assimilation worsens, the accumulation of insufficiently oxidized metabolic products increases intoxication.

• Nutrients should act not only on the affected organ, but also on the entire body by increasing the regenerative capacity of cells, to improve interstitial metabolism and the immunological status of the body.

This text is an introductory fragment.

Continuation for liters

90,000 Articles – Nutrition for tuberculosis

Nutrition for tuberculosis

Tuberculosis is a dangerous disease that takes away a huge number of human lives every year.To successfully combat tuberculosis, every possible means must be used. The main direction of treatment is drug therapy prescribed by a doctor. For additional support of the body, restoration of vitality, a balanced diet in tuberculosis plays an important role, since this disease depletes the body of a sick person. Do not neglect traditional medicine.

Tuberculous infection of the lungs is a disease caused by mycobacteria (rod-shaped bacteria or Koch’s rods).The causative agent is highly resistant to drugs. Infection is determined by the presence of areas of inflammation in the affected tissues, as well as the characteristic state of the body. The tubercle bacillus can persist for a long period in the ground, on things, in dry sputum. Also resistant to disinfectants.

The main route of spread of pulmonary tuberculosis is aerogenic (airborne), that is, the infection enters the body simultaneously with the inhaled air.In addition to this method, there is a possibility of infection through food or through contact with things contaminated with mycobacteria.

There are frequent cases when pulmonary tuberculosis proceeds without obvious signs. Detection occurs by chance, for example, with fluorography.

The earliest symptoms of the disease are:

• loss of strength;
• poor appetite and sudden weight loss;
• poor sleep;
• hyperhidrosis;
• dizzy and the temperature rises to 37 degrees;
• enlarged lymph nodes.

If you do not seek medical attention at the earliest stage of the disease, then over time these symptoms will be added: cough with sputum, shortness of breath, chest pain, hemoptysis. The last two symptoms indicate a complicated form of the disease and require prompt treatment.

General principles and objectives of nutrition, the ratio of proteins, fats, carbohydrates, daily ration

Therapeutic nutrition for pulmonary tuberculosis is extremely important for a positive outcome of the patient’s treatment.Nutrition of patients with pulmonary tuberculosis during treatment has the following tasks:

1. Provide strengthening of the immune system.
2. To supply the body with elements and substances that contribute to the body’s fight against the negative influence of bacteria, that is, to heal the foci of inflammation.
3. Improve metabolic function and improve the functioning of the gastrointestinal tract.
4. Restore and replenish the vitamin and mineral balance.
5. Increase the body’s defense response to intoxication.
6. To supply the body with a full-fledged diet in conditions of protein breakdown, poor carbohydrate and fat metabolism, increased consumption of vitamins and minerals.

Important nutritional guidelines for treatment:

1. Nutrition involves a varied diet, adjusted for the development of the disease process and general well-being.
2. Tight diets and restrictions can be used only for a short period (during the period of exacerbations and complications).
3. At all stages of therapy, fractional meals are prescribed.

It is necessary to follow the rules for the qualitative and quantitative composition of the diet, based on the stage of the disease, the current state of the digestive organs, existing complications and diseases.

Salt should be used with caution. If there are such pathologies as bone lesions, impaired renal function, then a special diet is prescribed to avoid edema. The diet implies that salt is completely eliminated. Fluid intake per day is somewhat limited.

Special attention should be paid to the ratio of proteins, fats and carbohydrates in the food consumed.

Proteins Since ancient times it has been known about the beneficial properties of the most common food. When medicines were not available, oats with baked milk was considered the main source of protein for the patient’s body.

At the acute stage of tuberculosis with obvious signs (vomiting, fever, dizziness, nausea), it is undesirable to eat foods with a high protein content. In the normal course of the disease, the daily intake of protein, on the contrary, should be doubled.

This is achieved by including a set of milk-based products in the menu – this protein is best digested by the body.Proteins have a positive effect on the infected organism, namely:

• helps to tighten the areas of inflammation;
• strengthens the immune system;
• along with food enriched with proteins, vitamins, especially of group B, enter the body

There is a list of products, with the exception of dairy products, with a high protein content, necessary for the patient. This is veal, lean chicken, fish.

Fats When choosing a diet in the treatment of tuberculosis, the main principle is to reduce the amount of fat consumed.This negatively affects the digestive process, since the human liver is primarily susceptible to dangerous overload. The amount of fat in the daily diet cannot exceed the average rate for a person (100 grams / day).

It is preferable to choose fat-containing foods on the basis of milk for tuberculosis, since milk fat is absorbed faster and does not contribute to obesity.

These are butter, cream and sour cream.

We will definitely have to exclude lamb and pork fat.It is worth paying attention to vegetable oils, olive or sunflower, as well as fish oil.

One third of all fat consumed must be of vegetable origin.

Carbohydrates Rational nutrition for tuberculosis infection requires a sufficient amount of carbohydrates due to the weakening of the pancreas. Its functioning must be maintained.

Content of carbohydrates per day – no more than 500 g, so as not to provoke obesity. A fifth of the normal amount of carbohydrates can come from the use of jam, sugar and honey.

It is better to give preference to carbohydrates contained in vegetables, cereals (buckwheat, oatmeal, pearl barley), potatoes, fruits, rather than fast-digesting carbohydrates from baked goods, bread, rice, millet and semolina porridge. Flour of the first grade and products from it – to a minimum.

There are so-called treatment tables or diets designed for different types of diseases. Usually in hospitals, patients are fed according to a specific table.

The Diet for Pulmonary Tuberculosis is a High Protein Diet! Includes:

1. Rye or wheat bread.
2. Any fish and meat dishes, with the exception of fatty types.
3. Milk and sour milk.
4. Steam, fried, hard-boiled eggs.
5. Cereal porridge.
6. Any fruits, vegetables, berries processed in different ways (some of them must be served raw).
7. In limited quantities – sauces and spices.

In general, the diet of tuberculosis patients should be varied and not include a large number of restrictions. But there are a number of products that can aggravate the process: hot spices, mustard, pepper, vinegar, horseradish.It is best not to eat foods that are too hot or too cold.

Required vitamins, traditional medicines

Therapy with anti-tuberculosis drugs adversely affects metabolic processes in the patient’s body, which negatively affects the endocrine and nervous systems. Vitamins and minerals well increase the tolerance of medications and accelerate treatment.

Vitamin C is of the greatest importance in the treatment of tuberculosis. A significant amount of it is found in citrus fruits, strawberries, and kiwi.From the vegetable group, it is better to choose cabbage, peppers, onions. Moreover, you can use them not only raw, but also as stews, soups or mashed potatoes.

In addition to vitamin C (ascorbic acid), vitamins of other groups (A, B, E) should be taken. With Vitamin B1 Deficiency, the patient may feel a general decrease in performance, get tired quickly, have a poor appetite, and suffer from muscle pain. To replenish it, you should eat liver, meat, egg yolk, peas, beans. To cover its deficiency, the attending doctor may prescribe the intake of medicinal vitamin complexes.Vitamin B2 is of great importance. Its lack negatively affects the mucous membranes. It can be replenished both from food and using synthetic forms. A decrease in muscle mass in a patient may indicate a lack of vitamin B12. An increased amount of vitamin is contained in liver, pork or beef.

What physical activity is permissible for pulmonary tuberculosis

Lack of vitamin A leads to problems with vision in the dark, to general ill health. Therefore, egg yolk, butter, liver, apricots, lettuce leaves should be added to daily food in order to overcome these symptoms.The worse you feel, the more retinol you need to add to your diet. A phthisiatrician can prescribe a daily dose of up to five mg.

Of great importance is the correctness of the joint intake of products containing retinol, but of different origins, for tuberculosis. Usually, vegetables containing retinol are recommended to be consumed with fats. For example, it is useful to combine carrot salad or lettuce with liver or fish in side dishes. This promotes the absorption of nutrients.

In case of tuberculosis infection, the sufficiency of vitamin E (tocopherol) is very important. There is a lot of it in vegetable oil. For this reason, doctors advise tuberculosis patients to make salad dressings with corn, soy, and peanut oils. In addition to oil, tocopherol is found in cereals and green leaves. For this reason, their use should be increased.

With an aggravated form of the course of the disease, an increased excretion of salts may be observed, therefore, products rich in phosphorus, potassium, calcium (nuts, dried apricots, sesame seeds, raisins, figs, milk and derivatives, lean meat) are introduced.

Nutritional features of sick children

It is necessary to pay special attention to the diet of a child with tuberculosis.

In order not to harm the body, you should be guided by some rules that will allow the child’s body to better endure the disease and recover sooner:

Observance of moderation in food. Often, moms and dads are mistaken in the belief that abundant food contributes to a speedy recovery. In fact, it is necessary that the baby eat a little, but with the content of a large number of vitamins and nutrients in this small amount.

1. Food must be well absorbed by the child’s body. Taking into account the fact that the infection destroys the immune system, you need to process food in such a way that it is easier and faster to digest. This will allow you to feed the sick child several times a day, but in small portions.
2. The diet should be enriched with fresh vegetables, fruits with a high content of vitamins. Usually, vitamins are more important for a child with tuberculosis infection than other nutrients consumed from food.
3. Use of fish oil is beneficial. In tuberculosis, this is important, as it strengthens the body and helps restore health. The recommended intake of fish oil for children from the age of three months is the dosage agreed with the doctor.

Balanced, rational, well thought out nutrition will be an excellent helper in the fight against tuberculosis. In addition, proper nutrition is an excellent prevention of tuberculosis. A targeted effect on the disease in all directions will accelerate recovery and increase the chances of a positive treatment result.

Ilya Melnikov ★ Nutrition for tuberculosis read a book online for free

Nutrition for tuberculosis

GENERAL DESCRIPTION

Tuberculosis is a predominantly chronic infection in which the lungs are most often affected. Less common is tuberculosis of the larynx, intestines, kidneys, bones and joints, skin. With tuberculosis, changes in the affected organs are possible, intoxication of the body, metabolic disorders, the work of various organs and systems, in particular the digestive system, are possible.

Nutritional regimen is, taking into account the nature and degree of organ damage, the general condition of the body, complications from other organs. The calorie content of the diet depends on the characteristics of the course of the disease, body weight and concomitant diseases. With an exacerbation of tuberculosis and bed rest, 2500–2600 kcal per day is sufficient. With half-bed mode – 2700 kcal; with attenuation of exacerbation – 3000–3400 kcal. In case of chronic pulmonary tuberculosis, especially in young people, a high-calorie diet is recommended – 3600 kcal.Eating more calories is not healthy. A quick and large increase in body weight may not improve, but worsen the patient’s condition.

TASKS OF HEALING NUTRITION

The main tasks of therapeutic nutrition for pulmonary tuberculosis are:

1. Providing the body with adequate nutrition in conditions of protein breakdown, deterioration of fat and carbohydrate metabolism, increased consumption of vitamins and minerals.

2. Increasing the body’s resistance to infection and intoxication.

3. Contribution to the normalization of metabolism.

4. Promotion of the restoration of tissues affected by tuberculosis infection.

To accomplish these tasks, it is necessary to introduce an increased amount of protein with food (at least 120–140 g), the consumption of which is increased in patients with tuberculosis. Highly digestible protein products (milk, fish, eggs, meat) are recommended. The amount of fat is recommended within the physiological norm (100-120 g). Fats should be given easily digestible, rich in vitamin A (butter, cream, sour cream), about a third – in the form of vegetable fat.

Amount of carbohydrates within the physiological norm (450-500 g). In cases where tuberculosis has a violation of carbohydrate metabolism, allergization of the body (allergic diathesis, bronchial asthma, chronic eczema), overweight, patients need to limit the intake of carbohydrates to 300-400 g, mainly due to easily digestible (sugar, honey, jam , syrup, etc.).

With an exacerbation of the tuberculous process, there may be an increased release of mineral salts (calcium, potassium, phosphorus, sodium chloride), therefore, foods rich in them (milk, cheese, cottage cheese, eggs, figs, dried apricots, raisins, meat and fish products, nuts etc.etc.).

With exudative pleurisy, transudate, tuberculous meningitis, with increased secretions in the bronchi, kidney damage leading to edema, a hyponatrium diet is prescribed, that is, food is prepared without adding table salt. This diet promotes increased urine output, resorption of fluid accumulated in the cavities, and the abatement of the inflammatory process. The liquid is injected in the amount of 900-1000 ml. With a large loss of blood, repeated vomiting, diarrhea, excessive sweat, the amount of table salt is increased to 20 g.

Patients with tuberculosis develop a deficiency of vitamins (especially ascorbic acid, vitamins A and B). The use of a sufficient amount of ascorbic acid increases the bactericidal properties of blood serum, increases the formation of antibodies, and reduces intoxication. The need for vitamin C is especially high in patients with a fibrous-cavernous process, at high temperatures and tissue decay. Of the products in this case, a sufficient amount of vegetables and fruits is recommended, and it is also necessary to periodically take up to 300 mg of ascorbic acid per day.

Patients with tuberculosis of the lungs, larynx, intestines and skin also need an increased amount of vitamin A – about 5 mg. To meet the need for vitamin A, dairy products, fish oil, egg yolk are recommended, as well as products containing carotene – carrots, tomatoes, apricots, red peppers, etc.

Particular attention should be paid to providing patients with B vitamins. They are directly related to protein metabolism, the need for which in this group of patients is increased.The diet should include foods rich in B vitamins – fresh vegetables, meat, bran dishes, brewer’s or baker’s yeast.

Read more 90,000 Tuberculosis patient lifestyle and nutrition

More than half a century ago, when there were no anti-tuberculosis drugs for the treatment of tuberculosis patients, nutrition was one of the most important therapeutic factors. Today, when medicine has a large arsenal of medicines for the treatment of this formidable disease, it is still impossible to achieve a favorable outcome in case of insufficient and irrational nutrition of the patient.

Tuberculosis intoxication leads to exhaustion of the patient, especially if the disease is detected out of time or has become chronic. The patient needs strength to fight the disease, needs “building material” for the functioning of the immune system. No immunostimulants will be helpful if the patient is not adequately fed.

Patients in a tuberculosis hospital receive a special diet containing an increased amount of protein and carbohydrates. What is protein? This is meat, dairy food, some plant foods also contain a high amount of protein.Preferred for patients with tuberculosis are lean meats – beef, chicken, fish. Easily assimilate chicken egg protein, cottage cheese, dairy products.

Fermented milk products are not only suppliers of protein, they also have a beneficial effect on the functioning of the intestines, intestinal flora. Products such as kurunga and kumis are widely used in anti-tuberculosis sanatoriums and some tuberculosis hospitals. A sufficient amount of protein in the diet helps to increase the defenses of the patient’s body.

Increasing the fat content in the diet of a tuberculosis patient is not recommended. There are such traditional medicines in the treatment of tuberculosis as badger fat, for example. The value of this easily digestible product lies in the content of vitamins A, E, unsaturated fatty acids, as well as some B vitamins (B2, B3, B5, B6, B12), organic acids, macro- and microelements, cytamines (bioregulators of a peptide nature). This biologically active product can, if desired, be used by patients, subject to ongoing anti-tuberculosis therapy.Carbohydrates are introduced into the diet of a patient suffering from tuberculosis not only in the form of easily digestible carbohydrates – baked goods, honey, cereals, but also in the form of slowly digestible – legumes, some cereals (buckwheat). Legumes are also a source of vegetable protein.

A prerequisite for successful treatment is the introduction of vitamins. Sources of vitamins are vegetables and fruits. Vitamin E is also found in unrefined vegetable oils and butter, cheese, nuts.Sources of vitamin A are carrots, pumpkin, eggs, liver, fish. The patient must additionally receive vitamins of group B (B6, B1) in the form of injections to ensure good tolerance of some anti-tuberculosis drugs, in particular, isoniazid.

In addition to proper nutrition, the patient needs to rethink the attitude towards tobacco smoking and approach the decision to quit smoking. As a result of constant exposure to tobacco smoke on the airways, the cells lining the airways are damaged, and chronic inflammation of the bronchi develops.With the concomitant tuberculous process, the risk of developing bronchitis increases significantly, smoking interferes with the restoration of airway cells and slows down the healing process. Tobacco smoking is the main causative factor in chronic obstructive pulmonary disease, a steadily progressive disease that leads to respiratory failure and then death. When smokers have tuberculosis, the risk of chronic obstructive pulmonary disease (COPD) is significantly increased. Therefore, smoking cessation is the key to a successful cure for tuberculosis.

The use of alcohol is completely unacceptable in the treatment of tuberculosis. It should be noted that people who abuse alcohol have a decrease in immunity, which, accordingly, adversely affects the course of tuberculosis. In addition, many anti-tuberculosis drugs have side effects on the liver, with additional alcohol load, toxic liver damage develops, which makes it impossible to take anti-tuberculosis drugs and prevents tuberculosis from being cured.Tuberculosis becomes chronic.

A dangerous side effect of alcohol consumption during treatment with anti-tuberculosis drugs can be toxic effects on the central nervous system: convulsions, psychosis, hallucinations.

Depending on the severity of the patient’s condition, the doctor prescribes bed rest, restriction of physical activity or, in case of a limited tuberculous process, the patient receives outpatient treatment. For the period of treatment, the patient is issued a sick leave.Due to the fact that tuberculosis is a contagious disease, the patient cannot go to work, even if he feels well.

After taking medication, the patient should lie down, daytime sleep or rest is very useful. There is such a concept – a medical and protective regime, i.e. sparing regime. You can not go in for sports, visit the bathhouse, sauna. The patient in the hospital, as the state stabilizes, expands motor activity, while fresh air and walks are useful, but cooling must be avoided.A patient suffering from tuberculosis must constantly remember that he has a contagious disease. For this, patients with bacterial excretion are hospitalized in a hospital. The patient must wear a mask, spit sputum into the spittoon, which is then subjected to special treatment. You cannot leave the hospital while bacterial excretion persists.

Coming home from a hospital, a patient can infect his family members, tuberculosis is especially dangerous for young children. If, during the initial examination, bacterial excretion is not detected, this does not mean that the patient is not contagious.It is necessary to wait for the results of the cultures, in addition, it can be assumed that the tuberculosis causative agent was not found in this portion of the sputum submitted for analysis, and in the other it may be present. Any active tuberculous process requires long-term treatment and isolation of children.

Thus, only a complex of health-improving measures, refusal from smoking and alcohol and taking anti-tuberculosis drugs contributes to the successful outcome of tuberculosis disease.

Protein diet for tuberculosis: what to cook? | Blog about tuberculosis.My diary

As I already wrote in my post about Nutrition for tuberculosis, it is very important to eat protein, since during chemotherapy, protein is broken down very quickly + absorbed longer, as well as as much vitamin as possible, especially A, C, B.

With good nutrition is very important for tuberculosis. This is considered part of the treatment. Earlier, in the 70s and 80s, tuberculosis was treated with essentially only fresh air and very good nutrition. Now, medicines have been added to these tips.

I wrote about medications here: “ Rules and new daily routine after diagnosis ”

MY DIET

I confess, my diet has not changed much.I still eat a lot of cereals, as well as fruits and vegetables. For a long time I did not eat milk, because I simply do not like it, but now I have added sour cream and cottage cheese to the diet. I cook cheese cakes or cottage cheese casseroles every other day. I also buy kefir, but I still haven’t taught myself to drink it every day.

Overall, my diet consists of 5 meals and fruit snacks. I don’t count calories, although a couple of days a week would be great to track protein.

For example, one of my days looks like this:

THE BEST IMMUNITY REMEDY FOR EVERYONE

Before breakfast, I drink half a cup of turmeric, ginger and lemon. This is a super immune booster, especially if you get sick. Useful for everyone. Remember!

BREAKFAST : oatmeal with a lump of butter + fruit (peach, banana, raspberry), a sandwich with cheese, tea or 2 egg scrambled eggs + toast with cheese + tea

SECOND BREAKFAST: a slice of cottage cheese casserole or gratin or salad, or stewed cabbage, or chicken leg with vegetables

LUNCH: borscht or soup, and / or the second (porridge, lentils + meat) + salad.Be sure to include greens, arugula, lettuce.

MIDDAY: cottage cheese casserole or a sandwich, or a piece of meat, or a boiled egg with vegetables, or hummus

DINNER: I confess that it is difficult for me to have dinner. So in time it turns out that you eat something all day, and by the evening you do not want to shove food into yourself at all. I can eat a salad or some porridge with a stew, or a slice of fish.

During the day I drink plain water and a couple of cups of tea, or rather, brewed mint, lemon balm, linden with lemon.They recommend a rosehip decoction, there is a lot of vitamin C. I also have 6 pills in total, and this is already 4+ glasses of water. In general, the water balance is maintained somehow by itself.

to be continued …

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