Tuberculosis treatment, herbal therapy - natural treatment and prevention research by Ray Sahelian, M.D.
Feb 12 2014

Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs but the tuberculosis bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. Tuberculosis disease was once the leading cause of death in the United States.

Transmission
Tuberculosis is spread through the air from one person to another. The bacteria are put into the air when a person with active TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected.

Diagnosis
A test to detect bacteria that cause TB and simultaneously determine if the bacteria are resistant to the antibiotic rifampin was approved by the U.S. Food and Drug Administration in 2013. The Xpert MTB/RIF Assay is less complex to administer than other screening tests for TB. Results are available in about two hours, while traditional methods to detect TB could take up to several months.

Natural supplements for tuberculosis
Anyone with TB needs to have a thorough medical evaluation and treatment with prescription anti tuberculosis agents. There are some natural herbs that have been tested in vitro or in animal studies for their influence on TB. Hardly any human research is available regarding the benefit of these herbs in tuberculosis prevention or treatment. I will provide a list of a few herbs that I have seen research on but in no way implying that these are effective in patients with TB or should substitute for proper medical tuberculosis treatment. There are several effective drugs for tuberculosis treatment and most doctors are familiar with their use. Here I will present research that I have come across regarding supplements that could be beneficial.

Mangosteen is a fruit that grows in tropical areas, mangosteen supplements are available.
Spirulina has been studied in children
Silymarin found in milk thistle to protect the liver from the damage that occurs from the use of anti tuberculosis drugs

Silymarin protects liver against toxic effects of anti-tuberculosis drugs in experimental animals.
The active components of silymarin had protective effects against hepatotoxic actions of drugs used in the chemotherapy of tuberculosis in animal models. Since no significant toxicity of silymarin is reported in human studies, this plant extract can be used as a dietary supplement by patients taking anti-tuberculosis medications. Nutr Metab (London). 2008.

PLoS Pathog. 2013. Vitamin D induces interleukin-1β expression: paracrine macrophage epithelial signaling controls M. tuberculosis infection. Although vitamin D deficiency is a common feature among patients presenting with active tuberculosis, the full scope of vitamin D action during Mycobacterium tuberculosis (Mtb) infection is poorly understood. As macrophages are the primary site of Mtb infection and are sites of vitamin D signaling, we have used these cells to understand the molecular mechanisms underlying modulation of the immune response by the hormonal form of vitamin D, 1,25-dihydroxyvitamin D (1,25D). We found that the virulent Mtb strain H37Rv elicits a broad host transcriptional response. Transcriptome profiling also revealed that the profile of target genes regulated by 1,25D is substantially altered by infection, and that 1,25D generally boosts infection-stimulated cytokine/chemokine responses. We further focused on the role of 1,25D- and infection-induced interleukin 1β (IL-1β) expression in response to infection. 1,25D enhanced IL-1β expression via a direct transcriptional mechanism. Secretion of IL-1β from infected cells required the NLRP3/caspase-1 inflammasome. The impact of IL-1β production was investigated in a novel model wherein infected macrophages were co-cultured with primary human small airway epithelial cells. Co-culture significantly prolonged survival of infected macrophages, and 1,25D/infection-induced IL-1β secretion from macrophages reduced mycobacterial burden by stimulating the anti-mycobacterial capacity of co-cultured lung epithelial cells. These effects were independent of 1,25D-stimulated autophagy in macrophages but dependent upon epithelial IL1R1 signaling and IL-1β-driven epithelial production of the antimicrobial peptide DEFB4/HBD2. These data provide evidence that the anti-microbial actions of vitamin D extend beyond the macrophage by modulating paracrine signaling, reinforcing its role in innate immune regulation in humans.

Effect of vitamin E and selenium supplementation on oxidative stress status in pulmonary tuberculosis patients.
A 2-month intervention with vitamin E and selenium supplementation reduces oxidative stress and enhances total antioxidant status in patients with pulmonary TB treated with standard chemotherapy. Respirology. 2008.

Evaluation of the efficacy of a plant adaptogen ( spirulina ) in the pathognic therapy of primary tuberculosis in children]
Lik Sprava. 2003.
The use of spirulina and its efficiency have been studied in a comparative aspect as a systemic biocorrector, in a combined treatment of tuberculosis in 26 children. It has been ascertained that application of spirulina as a pathogenetic means of remediation permits shortening the intoxication syndrome regression time, reducing the frequency of adverse reactions in administering antituberculous preparations.

New Drug Treatment for Tuberculosis
A team of scientists has synthesized two antibacterial compounds that may prove to be significantly more effective against tuberculosis (TB) than isoniazid, the leading anti-TB drug. One of the compounds called 2-HA, appears to be four times more deadly to TB bacteria than isoniazid, while the other, called 2-OA, proved 10 times more potent, according to a report in the journal Chemistry and Biology. A key feature of the new compounds centers on their ability to block several biochemical pathways that are critically important for the survival of TB bacteria.

Drugs Today 2013. Bedaquiline for the treatment of pulmonary, multidrug-resistant tuberculosis in adults.

Prevalence of Tuberculosis
Among communicable diseases, TB is the second leading cause of death worldwide, killing nearly 2 million people each year. It is estimated that about one-third of the world population are infected with tuberculosis (2 billion people) and about 10% of this figure will progress to disease state. Most tuberculosis  cases are in the less-developed countries of the world. Tuberculosis incidence has been on the increase in Africa, mainly as a result of the burden of HIV infection. Definitive diagnosis of tuberculosis remains based on culture for Mycobacterium tuberculosis, but rapid diagnosis of infectious tuberculosis by simple sputum smear for acid fast bacilli remains an important tool, as more rapid molecular techniques are being developed. Treatment with several tuberculosis drugs for 6 months or more can cure more than 95% of patients. Tuberculosis infection is particularly difficult to treat in special situation like pregnancy, liver disease, renal failure and when in coexistence with HlV / AIDS or the drug resistant state.
   An impediment to the control of tuberculosis has been the lack of a vaccine that provides long-term protection. Several vaccines are in the pipeline. An additional stumbling block to effective treatment of Tuberculosis is simultaneous HIV infection. Treating both diseases at the same time increases the risk of adverse drug reactions and other complications.

Reducing transmission
According to the World Health Organization, ventilation and some sunshine could reduce tuberculosis risks in hospitals and prisons, two strongholds of the contagious lung disease. In its Global Tuberculosis Control report, released in March 2009, the United Nations agency also doubled its estimate of how many HIV-infected people catch and die from tuberculosis, and warned especially deadly strains are continuing to spread in all corners of the world. Mario Pavilion, director of the WHO's Stop TB department, said that because tuberculosis bacteria thrive in stagnant air, "simply opening the doors" can reduce the chances that patients, inmates and others will become infected with the disease that killed about 1.8 million people in 2007.

Incidence and Prevalence of Tuberculosis
Although the current tuberculosis treatment strategy has helped cure nearly 20 million patients of tuberculosis, the incidence of TB continues to climb. Tuberculosis remains the leading cause of death from a curable infectious disease. The incidence of the disease remains steady in many areas of the world, but continues to rise in Africa, secondary to the spread of HIV infection.

2009
The U.S. tuberculosis rate hit an all-time low in 2008, but the infection continues to disproportionately affect minorities and immigrants. The CDC said 13,000 new cases were reported in 2008, also a new low, with 40 percent of those cases among people born in the United States. TB rates were 23 times higher among Asians, eight times higher among blacks, and 7 times higher among Hispanics than among whites. More than 10 percent of people who have tested positive for the AIDS virus had TB; the immune suppression caused by HIV can make a person far more susceptible to TB.

Reduce or eliminate smoking
A study in Taiwan has found that smokers are twice as likely to develop active tuberculosis compared to people who have never smoked, prompting calls for policymakers to be tougher on recommendations for quitting the habit. The study tracked nearly 18,000 people in Taiwan representing a general population for more than three years.

Tuberculosis in Africa
According to the World Health Organization (WHO), Africa has reacted too slowly to tuberculosis, an infectious disease that kills thousands of people with HIV and AIDS on the continent every year. African leaders and the United Nations health body declared a tuberculosis emergency in 2005 and the WHO has since launched a $56 billion global plan to halve tuberculosis prevalence and death rates. Worldwide, about 1.7 million people died from tuberculosis and 9 million people caught the disease in 2004. Africa's current crisis is linked to co-infection with HIV/AIDS and weak health systems.

China, Eastern Europe
Dangerous tuberculosis strains are thriving in China and the former Soviet Union, with up to 20 percent of infections in badly hit Azerbaijan resisting standard treatment. In high-income countries, only 1 percent of tuberculosis infections cannot be treated with two or more front-line drugs. However, in Eastern Europe, 20 percent of tuberculosis infections are multi-drug resistant, with especially high rates in former Soviet Azerbaijan, Moldova, Estonia and Latvia.

Drug Treatment for Tuberculosis
Tuberculosis infections resistant to both the first- and second-line antibiotics used against tuberculosis is increasing around the planet. The CDC and WHO surveyed a network of 25 tuberculosis laboratories on six continents from 2000 to 2004 and found that one in 50 TB cases around the world is resistant not only to the usual first-choice TB treatments, but also to many medications that represent the second line of defense. The survey looked at 17,690 tuberculosis cases that were analyzed for drug susceptibility. Of those, 20 percent were multidrug-resistant and 2 percent were extensively drug-resistant. The problem was worst in Latvia, where public health care deteriorated after the Soviet Union collapsed. Doctors believe tuberculosis develops resistance to drugs because some patients fail to complete a full course of medication.

While rates of fluoroquinolone resistance in Mycobacterium tuberculosis are generally low, patients who do have tuberculosis (TB) are more likely to have a resistant strain if they've been treated in the past with fluoroquinolones. August 15th 2009 American Journal of Respiratory and Critical Care Medicine.

Questions
Q. Do you think herbs and spices such as garlic and oregano can help someone with tuberculosis?
   A. Although the herbs and spices you mention have antibacterial activity, I have not seen any studies involving tuberculosis to know whether taking garlic or oregano supplements can help people who have tuberculosis.

What would be a good supplement for a young adult person who has been diagnosed with pulmonary tuberculosis and currently taking anti-biotics for it. She is oversees. What would be a good supplement to protect her kids from contracting the same disease? Generally if it is not a supplement specifically made for kids, what should be the dosage?
    Little clinical research is available regarding the role of natural supplements in the treatment or prevention of tuberculosis.