Diet in Typhoid – what to eat and most importantly “WHY”

Diet in Typhoid

In illnesses that affect the liver, diet restrictions are important. Typhoid and Jaundice are two such illnesses. It’s important to understand why diet needs to be controlled, otherwise, the tendency is to break the rules once in a while.

In the initial stages of the illness Salmonella Typhi has ruptured the intestines a great deal, so having anything fibrous or hard would irritate the intestines and harm them further. So semi solid food, juices, soups are advised in the first phase of chronic typhoid. Fat is to be avoided as it is difficult to digest, spices are to be avoided as they would irritate the wounded intestines. Also in the first phase, there may be vomitings and diarrhea. If these exist, one needs to have lots of liquids. To replace the lost body fluid and salts, intake of ORS, fruit juices, buttermilk, soups and pain water are advised. The rule of thumb is to have about 3-4 liters of water in any form.

Once the illness is controlled, the doctor may start you on solids but would restrict ANY OIL, FAT, Non Veg, and Caffeine. I was never able to understand why this was so and often resorted to few drops of oil in my food which did me further damage and prolonged my illness to over 6 months. So I want to spend time explaining why the doctors instruct us to avoid oil and fats. OIL is heavy to digest but more importantly, Salmonella hides in the gallbladder, eating oil leads to secretion of bile juices from the gallbladder for digestion, which carries the bacteria back to the intestines. The whole idea is to repair the infection caused by Salmonella, therefore, while the body is fighting the bacteria in the intestines, if more get dropped through the bile juice, the fight becomes harder. So any stimulant that increases the chances of inactive, hidden Salmonella reaching the intestines is to be avoided until the infection already caused is controlled. Once the infection is controlled, body can fight the new entrants at a later point (as fighting the earlier batch of the bacteria caused the same effect as any vaccine, building immunity against Salmonella)

It’s important to understand that in addition to avoiding oil and fat, ingredients like coconut, peanut, milk etc. that are fatty should also be avoided. Non veg, tea, coffee are supposed to be stimulants for the bacteria and should still be avoided. Note that Spices can be started at this point as the intestines are now healed.

1.       Boiled rice, bread (roti),

2.       All Lentils (dals) – Tur, Moong, Rajma, Kali Dal, Urhad, Chana

3.       Curd (from low fat milk). Curd is an excellent probiotic. Have as much as you can

4.       Steamed idly with sugar or any chutney (no coconut or groundnut. Use Chutney dal)

5.       Bread with Jam

6.       All fruits, All Juices - One fruit that I would highly recommend is Banana. Have 6,8,10, up to 12 bananas in a day. It's rich in carbs and a bunch of minerals such as Potassium. It doesn't hurt the stomach and provides much needed energy. Also helps with the early morning cramps in the stomach and acidity. I never liked bananas before but when I was down with Typhoid, I felt like eating them all the time. I would have 2 big bananas as soon as I woke up in the morning (at 6am), 2 at 11 AM, 2 in the afternoon at 4 PM and 2 before sleeping at 9 PM. Other fruits/ juices I consumed were Chikoos, Watermelon Juice (2 glasses in the morning), Pomegranate and Orange Juice (1 glass in the evening). I couldn't eat “hard” fruits like Apple and Guava as they were hard to digest (high iron content in Apples, hard seeds in Guavas) & would cause an upset stomach.

7.       All vegetables (without oil) – These are a lot easier to cook and eat than it sounds. We are so used to the spices (tadkas) that we have come to believe that it’s the oil that cooks the food. After eating the delicious Okra/Lady’s Finger ( Bhindi), Cauliflower (Gobi), Fenugreek (Methi) and Spinach (Palak) vegetables cooked without oil (one just needs a nonstick pan and a lid to do the magic), I’ve come to wonder why the original recipes need one to use oil.  

Update 19th Feb 2017 - Over the last 2 years, since I wrote this blog, I've received a lot of queries around quick recipes for typhoid diet.  The thumb rules for a healthy and easy to digest diet for typhoid patients  are:

1. Food prepared for typhoid patients needs to be fresh (refrigerated food is not preferred)

2. There should be no trace of oil, butter or ghee

3. Food should be very easy on the stomach, light and soft

4. Spices, chilies are to be completely avoided 

Idlies, bananas, boiled daals, rice and bread are absolutely safe to be consumed. Since the diet restriction for typhoid lasts for a month, sometimes a couple of months, it becomes really tough to have the same diet over and over again. My mother used to make some porridges that tasted good, had a high nutrition value an and were easy on the stomach. She used to prepare the mixture once a week and both me, my 9 month old son and others in the family that had digestion troubles would feast on those preparations. You can try making this one quick powder yourself - it needs powdered rice (wash and dry the rice and then roast it before grinding), Powdered mixture of roasted urad daal, moong daal and toor dal, roasted powdered ajwain. This mixture can last for several months. When hungry, a few spoons need to be cooked in boiling water. It's delicious and very easy to digest. It works as a great carry food when on the wheels. If you want to get this powder shipped to your doorstep, let me know . All the ingredients used would be organic and custom made for the order and shipped through courier. Therefore, the costs would be slightly higher. Nevertheless, if you are interested in trying out some of the following, send me an enquiry by filling the form here

1. Complete meals (250 gms for 250/-)
1. Moong daal porridge
2. Urad daal porridge
3. Toor daal porridge
4. Moong, Urad and Toor dal porridge mix
2. Energy boosters (250 gms – 550/-)
1. Anjeer, Khoob kala and Munnaka – I first came across this effective mixture for typhoid in this video from Ramdev baba. It works well when consumed in the early stages of typhoid. Although I started consuming it much later, it still worked for me.
3. Snacks (250 gms for 150/-)
1. Suji upma mix – This has all the roasted ingredients and roasted Suji. One would need to boil the mixture in hot water and consume.
4. Digestive aids (100 gms for 150/-)
1. Ajwain, methi and kaala jeera mix – this mixture needs to be taken at night, with warm water. It relieves acidity and improves overall health of the digestive system.

Other posts on Typhoid

1. Chronic Typhoid - Story of my miraculous escape
2. Typhoid (Salmonella S Typhi) Fever- Causes, Symptoms, Diagnosis, Types and Prevention
3. Typhoid Treatment and home remedies
4. Typhoid Vaccine - Oral and Injectable
5. Typhoid travel guide for travelers to India

Typhoid FAQs

Following is a list of questions and answers from my doctors and my own experience. For more details on Typhoid and cure, visit the posts on the main site - www.typhoid.co 

 

 

Q1:When can we confirm that typhoid is fully cured? I have finished the 21-day antibiotic treatment.

A1:Get Widal and ESR checked. A positive widal with normal ESR is good as it indicates you don't have an active infection. Also, you should not have any fever, diarrhea, nausea, headache. Weakness is the most important indicator of complete recovery in case of Typhoid. If you have weakness, continue to take rest and control your diet. This will help the body to fight the disease.

Q2:Can Typhoid make me infertile?

A2: Some studies suggest infertility in men suffering from Typhoid, however it's not an established fact. Women suffering from Typhoid have experienced delayed periods but a permanent effect on fertility is not observed. Please consult your doctor for more details.

Q3:Can I conceive if I have Typhoid?

A3:No, doctors strictly discourage pregnancy until 3 months into recovery.In addition to nutrient deficiencies in the body due to the malabsorption caused by Typhoid, the chances of relapse may pose significant risks to pregnancy.

 Q4:What kind of food should someone suffering from typhoid have?

A4: In the active phase (ie, when you have fever, diarrhea), only semisolid foods, soups and fruit juices are allowed. In fruits, banana and Chikoo can be consumed as much as possible. Curd should be consumed in the form of buttermilk as it has the necessary probiotics to help in digestion and enable the body to fight the Typhoid bacteria.  Idly is a good choice at this time. Note that here's a restriction on FAT/OIL, non veg, milk in the active phase of the illness. In the recovery phase (when fever is gone and diarrhea is controlled), all foods can be tried. Avoid fat, oil and nonveg to prevent Typhoid relapse. If any food gives you diarrhea or gas/flatulence, avoid it for a week and try again. Recovery phase can be as long as a month or more. The more care you take in this phase, the better are your chances to get cured completely.

Q5:I am suffering from typhi "o"(typhoid) what should I do now ? 

A5: Visit the doctor, plan you diet and take the medicines prescribed by your doctor - you will be given antibiotics, antacid, probiotics, multi vitamins and Liv52. Take bed rest for 2-3 weeks to make sure you recover completely. Start taking Neem, Honey and Cinnamon and practice Anulom Vilom.

 

Q6:Can I exercise when I have Typhoid?

A6: Only mild exercised are allowed during Typhoid and in the recovery phase. Exerting the body may lead to reoccurrence of Typhoid. Small walks and pranayama are effective.

 

Q7:Can I eat oily food in Typhoid?

A7:Oil is to be avoided during Typhoid as eating oil triggers the secretion of bile juice from gallbladder and the bile juice carries the hidden typhoid bacteria (Sallmonella S Typhi) into the intestines. I have explained why oil needs to be avoided in this post on diet in Typhoid.

Q8:Can I eat spicy food in Typhoid?

A8: You can start eating spicy food in the recovery phase, ie when there is no fever, diarrhea. Observe your digestion when you have spicy food. If you can tolerate spices, you can go ahead with spices. But remember to restrict Oil until you are fully recovered.

Q9:What is the antibiotic given in Typhoid?

A9: I was given different combination of antibiotic. Ofloxacin 400 mg, twice a day for 4 weeks was the strongest dose of antibiotic given to me. Other effective antibiotics are ampicillin and amoxicillin. Both oral and IV antibiotics can be given, the doctor takes the call based on patient's condition. IV is considered when patient's condition is critical and immediate control is required over the illness. Additionally, some patients do not respond to oral antibiotics, consequently, IV needs to be administered. 

Q10:When to visit the doctor in Typhoid?

A10: In the beginning, Typhoid must be diagnosed correctly. So visit the doctor when if have severe diarrhea, headache and fever. Unexplained weight loss and fatigue are also a common symptoms of Typhoid.  Once the diagnosis is done, the doctor will tell you the next course of action and plan your next visit.

 

Q11:Can I eat non veg in Typhoid?

A11: Non veg is a stimulant for the hidden bacteria in the gallbladder as it is fatty. So avoid non veg and eggs until you are fully recovered

 

Q12:Why is there hair loss in Typhoid?

A12: Typhoid impacts absorption of nutrition in the body. So the body resorts to using the stored fat and muscles in the body. Over a period of time, there's deficiency of vitamins and protein in the body. Protein and B12 loss leads to hair fall.

 

Q13:My Typhoid is cured but why do I still have indigestion, pain in the stomach and gastric issues?

A13: Once sick with Typhoid, it takes months to get back the normal digestion. Avoid taking antacid pills for a long time. Take Honey and Cinnamon drink to help with the acidity and other digestion troubles. It's very effective and the relief is immediate.

 

Q14:What are the home remedies for Typhoid?

A14: Neem leaves, Honey Cinnamon drink, cloves, garlic, banana, Bel fruit are effective in Typhoid fever. Find more details in this post on Typhoid treatment

 

Q15:I have Typhoid. I am worried I may spread it. How can I prevent my family members from getting it?

A15: To prevent spreading Typhoid, you must understand how the disease spreads. Typhoid bacteria can be excreted by a Typhoid patient in the stools or Urine. Keeping this in mind, following are the preventive measures you must take to keep your friends and family away from contracting the disease:

1. Thoroughly clean your hands with and antibacterial soap, taking care to rub your fingernails while washing your hands. 
2. Cut your fingernails short to avoid getting the bacteria in the nails
3. Properly flush the toilet every time you use it.
4. Clean your bathroom with an antibacterial cleaning agent. Alternatively, add Dettol to the water and clean the toilet.
5. Insects can carry the bacteria from contaminated areas to the rest of the house. Make sure there are no flies, cockroaches or any other insects in the toilet or the house.
6. Get children and elderly members of the family vaccinated with Typhoid shots. These are available for under 200/- and can be given by a doctor only.

 

Q16:I have had typhoid fever for 15 days. I took the medicine and I'm still having symptoms. What should I do now?

A16: If you still have the symptoms, it's clear that you have still not recovered. Typhoid is a long running illness. So don't lose heart. Continue to take rest and control your diet for 2 more weeks and few more weeks if needed. Be strong and try to keep your mind healthy by practicing Anulom Vilom. One thing I have come to learn from my experience is that a weak body and mind is the most likely to carry the illness for longer. the moment you control your ever wandering mind and take control of your body, you are going to get better, for good.

 

Q17: Can I give typhoid vaccine to my baby at 9 months in India?

A17: Yes, India Academy of Pediatrics now recommends Typhoid vaccine at 9-12 months. Refer to the released notes for vaccination schedule for children, 2014 here. More details about the same are captured in the post on Typhoid Vaccine.

 

Q18: Can I take other vaccines for other diseases when I am suffering from Typhoid?

A18: It depends on your health and the urgency of the vaccine. Usually, if there's no fever or severe symptoms of Typhoid, doctors give vaccination. I was given Flu vaccination while I had Typhoid as there was an outbreak of Swine Flue in India, in January 2015. In general, since immunity is low during Typhoid, it's better to take vaccinations for the illnesses one is susceptible to catch.

Q19:I suffered from typhoid, it was not severe typhoid .I have taken treatment for 10 days and now I have become very weak.

A19: Pranayam, Anulom Vilom is very effective in getting back the lost strength. Try practicing Anulom Vilom for atleast 1 hour a day.

Q20: When I was of 10 yrs old, I suffered from typhoid. Since then after every 2 or 3 yrs, I usually suffer from typhoid. I want to completely eradicate it.

A20: Consider taking Typhoid vaccine. Also keep yourself strong and healthy to avoid the recurrence of the disease. My experience with Typhoid is that it tends to attack when the body is generally weak. have 20-30 neem leaves 3 times a day to help eliminating the bacteria from the body.

Q21:Who should take Typhoid Vaccine?

A21: People living in countries that have high numbers of Typhoid breakouts and are immunocompromised, are on steroids, have diabetics, are old, live in hostels, eat food from outside regularly, children, work in medical labs should get vaccination. Additionally, people travelling to Typhoid stricken countries should take the vaccine.

Q22: How long does it take to build immunity after taking Typhoid vaccine?

A22: 1-2 weeks

Q23:What is the efficacy of Typhoid vaccine? Can I get Typhoid even after taking vaccine?

A23: Research claims high efficacy of Typhoid vaccine - up to 80%. However, it's still best to take precaution and avoid contaminated food/water.

Q24: What foods can be taken in Typhoid in the recovery phase, when there is no fever, diarrhea and vomiting?

A24:All fruits, Idly,Curd rice,slim milk, Payasam, Glucose, Juices and Soups, Rava/Sooji, all dals. Idea is to avoid fat as much as possible. You can take spices in the recovery phase. Just listen to your body. If eating something makes you feel funny in the stomach or gives you diarrhea, stop eating it. Like I could never digest milk and cucumber all through out the 7 months, so I avoided these totally.

 

Q25: How long should the Typhoid diet be continued after Typhoid?

A25: For up to one month. If the widal and ESR are high and the person is generally feeling weak, the disease is believed to still be present and the diet needs to be continued for longer - upto 3-4 months.

Q26: Can I have alcohol when suffering from Typhoid?

A26: No. Alcohol impacts the liver and liver is severely compromised during Typhoid. Stay away until you fully recover

Q27: What are the common symptoms of Typhoid

A27: Fever, Diarrhea, headache, Abdominal discomfort, red spots on the body are some of the common symptions of Typhoid. For more details, view this post on Typhoid symptoms.

Q28: What are the home remedies for Typhoid?

A28: Honey and Cinnamon, Cloves, Garlic, Neem leaves and Anulom Vilom are very effective in curing Typhoid. For more details, view this post on Typhoid treatment.

Q29: Why does Typhoid relapse

A29: Typhoid may occur again either due to a reinfection (consuming Typhoid infected food again) or when the inactive bacteria in the Gallbladder (also called the carrier stage) pass on to the intestines and reattack the body.

Q30:I have had Typhoid last year. Have I developed immunity to the disease for lifetime

A30: It's difficult to be sure if one developed immunity to Typhoid after contracting it. There are several people that get down with Typhoid every year. So it is advised to take Typhoid vaccination if you are susceptible to the disease and take precautions by avoiding contaminated food.

Q31: Can I have tea and coffee in Typhoid

A31: No. Tea and Coffee impact digestion and also may stimulate the secretion of bile juice, resulting in reinfection.

 

Q32: What are the tests done in Typhoid and what is cost?

A32: To start with, Widal and ESR are done. If widal is positive and ESR is also elevated, there may be an active infection. Doctor will ask you to do a CBP (complete blood picture), LFT (Liver function test) and an abdominal scan subsequently. Also a CUE (complete urine examination) is done to check if the bacteria has infected the urinary tract. Very rarely, Doctors may do a blood culture and sensitivity test to isolate the strain of bacteria which is slightly expensive. In India, typical cost of the tests are as follows (INR): CBP-300/-, ESR - 200/-, Widal-200/-, CUE-100/-, LFT- 700/-, abdominal scan -1000/-, Blood culture and sensitivity- 2000/-

Q33: What is the difference between Typhoid and Paratyphoid?

A33:In addition to nutrient deficiencies in the body due to the malabsorption caused by Typhoid, the chances of relapse pose significant risks to the p  A33: Typhoid is caused by Salmonella S Typhi and is a more severe form of Typhoid. Salmonella Para Typhi is another strain of Salmonella bacteria and causes a milder form of Typhoid. In India, usually people are infected with both together. ParaTyphi leads to diarrhea and green stools.

 

Q34:Can I breast feed if I have Typhoid? 

A34: Yes, Typhoid bacteria does not get passed into the breast milk, so there is no fear of transmission of the disease from the mother to the baby. In fact, Pediatritions advice that breastfeeding be continued as the baby receives the antibodies for Typhoid through mother's milk that help preventing the baby from greeting sick with the disease.

Q35: Does breastmilk production reduce when the mother has Typhoid?

A35: My experience is that there is a significant reduction in the breast milk when the mother is suffering from Typhoid. It may be so as the overall nutrient absorption is impacted due to the compromised digestive system. If you notice a drop in your feed, consult your pediatrition and supplement the feed with formula milk.

 

Q36: I am suffering from Typhoid. How often should I get tested for Widal?

A36: Like any disease, once detected with Typhoid, the patient wants to get well soon. However, the difference between other diseases and Typhoid is that the latter does not have clear boundaries for the disease state and recovery state. In typhoid, the patient continues to remain weak for months together and lives in the fear of a relapse. Therefore, the tendency is to keep getting Widal and ESR tested and hope the values are in favour of the patient. When I was actually suffering from Typhoid for seven months, I was weak all the time and felt like getting Widal and ESR done everyday, hoping the tires would go down. When I actually got well, I just didn't have the time to go yo the lab for giving blood sample for the tests. My view is that you can get the tests done as per doctor's prescription (which usually is once in 3-4 weeks) or just do whatever makes you feel good and gives you the peace of mind. Remember, we need to pamper our much affected mind during Typhoid.Choose anything that helps you do that. 

 

Q37: I have become very irritable since the time I have picked Typhoid. Also I am depressed whole day,can't sleep at nights and have lost confidence in myself. Please help.

A37: Don't worry. Just be aware that Typhoid impacts the mind a GREAT deal. Our ancestors used to call it the illness of the mind.Know that this state of mind will be gone once you recover from Typhoid, and with that put all your will power in getting cured. Anulom Vilom is an EXCELLENT remedy to gain the lost control over your mind. As I've called out before, do it at least for an hour a day.