Dietary taboos for taking tuberculosis drugs

Foods that can directly react with drugs to induce poisoning, drinks/recipes that can significantly increase the metabolic burden on the liver and kidneys, specific foods that can induce discomfort and aggravate the side effects of drugs, and other so-called "can't eat eggplants", "can't drink milk" and "can't touch spicy food" are mostly individual experiences without universal reference, and do not need to be followed blindly.

I met a young man in his early 20s who was greedy after taking isoniazid for half a month. He ate pickled hairtail that had been stored at home for two days. His face turned red, he had a headache and he was panicked half an hour after eating. It was not until he went to the emergency room that he learned that he was suffering from histamine poisoning. Isoniazid inhibits the enzyme that metabolizes histamine in our body. If you come into contact with foods that exceed the standard of histamine, such as stale sea fish, fermented cheese that has been stored for a long time, homemade pickles, etc., your histamine will not be excreted. In mild cases, you will develop a rash and dizziness, or in severe cases, you may even have difficulty breathing. This kind of food must be completely avoided. Don’t try it on your own body.

Oh, by the way, let me clarify the most widespread misunderstanding: many people say that you cannot drink milk or tea while taking rifampicin. In fact, this is not absolute. Clinical guidelines in the early years would recommend completely avoiding dairy products and tea while taking rifampicin to avoid the combination of tannic acid, protein and drug ingredients that affects the absorption rate. However, large-sample follow-up data in recent years show that as long as the medication time and milk and tea drinking time are staggered by more than 2 hours, the impact on blood drug concentration is almost negligible. Nowadays, many young doctors encourage patients to drink more milk to supplement protein. After all, tuberculosis is a wasting disease, and keeping up with nutrition is the key to recovery. You can't even skip high-quality protein just for the sake of the avoidable effects, right?

There is another category that must be bitten and not touched: alcohol, folk remedies with unknown ingredients, raw Polygonum multiflorum/Tu notoginseng and other things that are clearly hepatotoxic. Don't believe that "it's fine if you just drink two sips of beer". I've seen people who drank cold beer twice a week while taking tuberculosis medicine, and their transaminases soared to more than 800 in two months. As for fried foods that are high in oil and sugar, there is no need to completely ban them. If your liver function has been stable, it is perfectly fine to eat fried chicken once a week to satisfy your craving. Just don’t do it every once in a while. After all, the liver has to metabolize drugs and process junk food. If the load is too heavy, it is easy to stop. Just control this yourself.

Regarding whether high-purine foods should be avoided, there have always been two opinions in clinical practice: one group believes that as long as pyrazinamide is consumed, it should be completely banned to avoid inducing gout.； The other group believes that it depends on the situation. If you have a history of gout, or if your uric acid has soared above 500 μmol/L after taking medication, you must strictly avoid foods with high purine content such as thick broth, animal offal, and shelled seafood. ； But if you don’t have gout and your uric acid has stabilized at normal values ​​after taking medicine, there is no need to completely give up high-quality protein sources such as shrimp and lean beef. If you usually drink more warm water to promote uric acid excretion, you will basically not have any problems.

As for the "can't eat eggplants", "can't eat spinach" and "can't eat spicy food" that are so popular on the Internet, there is really no universal reference standard. If you do get a rash or itchiness after eating eggplant, then don’t touch it ； If you are worried that spinach has too much oxalic acid, blanch it in water for 1 minute to remove 80% of the oxalic acid, so you won’t be afraid to eat it at all. Not to mention the spicy food. If you are from Hunan and Sichuan, you won’t feel stomach discomfort if you eat spicy food every time. There is no need to stop eating spicy food. It is easy to lose your appetite when taking tuberculosis medicine, and you can’t even eat your favorite flavors. You can’t eat enough to keep up with your nutrition, which actually slows down your recovery.

The most exaggerated patient I have ever seen. After hearing what was said on the Internet, he did not even dare to eat soy sauce. He ate white porridge with boiled vegetables every day. He lost 8 pounds in a month. During the follow-up examination, the lesions were not absorbed at all, and the doctor laughed angrily. Think about it, the Mycobacterium tuberculosis bacilli consumes your nutrients in your body, and you don’t dare to eat this or that. You don’t even have the ammunition to fight the germs. How can you get better quickly just by relying on drugs?

To put it bluntly, the dietary taboos for taking tuberculosis medicines are not that complicated. Don’t touch spoiled fermented foods and stale seafood, don’t drink alcohol, and don’t blindly follow folk remedies. The rest will follow your body. If you don’t feel uncomfortable, eat normally. Add more protein and eat more fresh vegetables. It’s better than anything else. After all, taking medicine is hard enough, so don’t make it difficult for yourself about eating.