Diet taboos for tuberculosis and high uric acid

Don’t eat foods that are high in purine and high in fructose, which will increase the metabolic burden on the liver and kidneys. At the same time, don’t blindly avoid high-quality protein in order to lower uric acid, which will delay the healing of tuberculosis lesions.

This is not said out of thin air. In clinical practice, nearly 40% of patients who take first-line anti-tuberculosis drugs will suffer from obstruction of uric acid excretion due to the side effects of pyrazinamide, and the number will increase. If there is a history of gout, some may be in pain so much that they cannot get out of bed. Last month, I met a 27-year-old young man during a follow-up visit at the tuberculosis clinic. His uric acid had soared to 720 μmol/L after taking medicine for two months, and his ankles were so swollen that he couldn't wear shoes. He asked me if I should stop drinking milk and eggs every day. He also said that his family did not allow him to eat any meat, so he was given white porridge with vegetables. When I heard this, I quickly stopped him - this is not a taboo, and it will delay the recovery from tuberculosis.

First, we must clearly define the minefields that really cannot be touched, so as not to waste good food indiscriminately. Many people blacklist all seafood and meat when they hear that they are high in purine. In fact, it is really unnecessary. Foods such as sardines, hairtail, animal offal, hot pot soup, and Laohuo Jingtang with a purine content of more than 150 mg per 100g must be completely avoided, especially those that have been stewed for several hours. The purine in the meat is completely dissolved in the soup. Drinking one bowl will increase the purine level faster than eating three meals of red meat. Don’t believe the old saying of “drinking soup to replenish nutrition.” If you really want to supplement nutrition, eating stewed lean meat is 10 times better than drinking soup.

There is also an invisible mine that many people don’t know – high-fructose foods. Some people think that if you have high uric acid, it is always right to eat more fruits and drink more freshly squeezed juices, right? What a mistake. Fructose entering the body will accelerate the synthesis of purine, but will increase the level of uric acid. Especially freshly squeezed juices that remove dietary fiber will double the fructose concentration. There are also milk tea, carbonated drinks, honey water, and even very sweet lychees, longans, and mangos. Eating too much at one time can cause problems. I had a patient before who couldn't lower his uric acid without taking a sip of broth. After asking, he found out that he drank 3 bottles of iced black tea every day to relieve the bitter taste of anti-tuberculosis medicine. After stopping, his uric acid dropped by more than 100 in less than two weeks. Do you think this is unfair?

As for "can we eat soy products" and "can we drink soy milk" that everyone is arguing about a lot, there is actually no unified conclusion in the academic circles. Some studies say that soybeans are high in purine and should be avoided. Others say that the plant purine in soybeans has a very low absorption rate by the human body, but it can also help reduce uric acid. My suggestion is that if your uric acid is still above 500 μmol/L, or you have already had a gout attack , just don’t eat whole soybeans or freshly squeezed soy milk. If the uric acid has stabilized below 480, eat a small amount of processed soy products such as tofu and dried tofu, and there will basically be no problem. If you are not sure, just ask your attending doctor for a follow-up check-up next time. There is also the issue of drinking water. Some people say that you should drink 2500ml of water every day to promote uric acid excretion. Others say that if you have pleural effusion due to tuberculosis, you should drink less water. This is actually not conflicting: if you do not have pleural effusion and do not have heart or kidney insufficiency, drinking more warm water is fine. If the doctor has clearly told you to limit water, don’t force it. Following the doctor’s advice is always the first priority.

The most important thing is to go to extremes. In order to reduce uric acid, eat a vegetarian diet. You must know that tuberculosis is a wasting disease, and you must have enough protein to make the lesions grow. Eggs and low-fat milk are proper low-purine and high-protein foods. Eat them with confidence. One egg and two boxes of pure milk every day are perfect. No problem. Cut meats such as lean pork, chicken breast, and grass carp that contain purine into small pieces and blanch them in cold water for 5 minutes. This can remove 30%-50% of the purine. Eating about one or two at a time not only supplements nutrients, but also does not cause uric acid to float too much. It is much better than white porridge and vegetables.

In fact, to put it bluntly, the diet at this stage does not have so many rules. Avoid clear minefields, don’t go to extremes, be careful before eating, and write down if you are really unsure, ask the doctor for the next review. This can control uric acid without delaying the rapid recovery of tuberculosis. That is enough.