Tuberculosis: How improved nutrition can reduce TB cases?

The Indian government has been actively engaged to bring an end to TB for more than 50 years. One of the country's severe health crises, TB kills approximately 480,000 Indians every year which is almost 1,400 lives a day. This excludes the millions of missing cases which are either treated in private sectors or are undiagnosed or insufficiently diagnosed.

The National Strategic Plan for Tuberculosis Elimination in India has targets of an 80% reduction in incidence and a 90% reduction in tuberculosis mortality by 2025. As per a 2021 report by the World Health Organisation (WHO), India is among those countries where TB cases account for more than two thirds of the global total.

A new study published in the Lancet has given a new direction to the treatment of tuberculosis, which affects close to 3 million Indians. The study was conducted in Jharkhand and sheds light on the relationship between TB and good nutrition. The researchers have offered evidence on one of the most striking causes of TB deaths in India, which is undernutrition from the Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) trial. A total of 2,800 TB patients were studied. The researchers found that improved nutrition can reduce the incidence of TB by 40%; it can also reduce the risk of infectious TB by 50%. The study also found that early weight gain in underweight TB patients can reduce the death risk by 60%. The risk of instant death was reduced by 13% for a one percent weight gain and it reduced by 61% for 5 per cent weight gain, the study found.

"A healthy diet and nutritional build-up can pace up an individual's recovery from tuberculosis and also at same time if taken care among close contacts can reduce chances of them developing it as shown by recent RATIONS trial. TB weakens your immune system, kills your appetite, and in turn causes your body to go into catabolic phase. Nutritional support builds your immunity and especially weight gain is a major indicator towards recovery from disease," says Dr. Shivanshu Raj Goyal, MD-Pulmonary Medicine, Consultant Pulmonologist and TB Specialist, Artemis Hospitals, Gurgaon.

Dr. Goyal says more consumption of vitamin B-rich foods, having leafy, dark greens like kale and spinach, whole grain cereals etc., consuming calorie-rich foods like banana, rava, and peanuts; eating unsaturated fats like olive oil and having seasonal fruits are extremely good for those with TB. "Vitamins A, C, D, and E are antioxidants that destroy harmful oxygen molecules called free radicals and protect the body and enhance the nutritional value. Protein-rich foods like eggs, fish, jowar, bajra, soyabean and tofu should be added to the diet. Zinc and selenium-rich foods such as nuts and seeds including mushrooms are good for those with TB," advises Dr. Goyal.

Dr. Goyal recommends avoiding refined carbohydrates such as flour and sugar as they provide empty calories devoid of nutrients. Fried foods, trans fatty acids should also be avoided, he says. One should check with the doctor for a diet chart.

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Dr. Goyal highlights one of the most critical aspects of nutrition which is unhealthy lifestyle factors. These factors, he says, interact with nutrition in influencing TB risk. He advises to completely refrain from consuming alcohol, drugs, and tobacco smoking. "These would decrease lung defence and would reduce its ability to absorb nutrients from the gut," he explains. "Those in the high-risk group should avoid overcrowding their diet and aim to have a balanced meal," he adds. "Apart from nutritional build up, most important step is to complete course of anti TB medication and adequate dosing as per your doctor or DOTS TB center," he advises.

The common symptoms of TB are prolonged cough, chest pain, weakness, fatigue, weight loss, fever and night sweats. Certain conditions like diabetes, HIV or AIDs, malnourishment and tobacco consumption prompt the disease in individuals. It is a common perception that TB only affects the lungs, whereas the fact is that it can also affect the kidneys, brain, skin and also the spine.