Why dietary vigilance is essential while on Enbrel
Enbrel, or etanercept, is a biologic medication used to treat autoimmune conditions like rheumatoid arthritis, psoriatic arthritis, and plaque psoriasis by blocking tumor necrosis factor (TNF), a protein that causes inflammation. By doing so, Enbrel effectively suppresses the immune system to control the disease, but this also leaves you more vulnerable to infections, including those from foodborne bacteria. While there is no known direct interaction between Enbrel and specific foods that would interfere with drug absorption, the dietary restrictions are centered on preventing food poisoning and managing inflammation related to the underlying disease.
Foods that increase infection risk
Because your immune system is compromised, certain foods with a higher risk of containing harmful bacteria, such as Listeria or Salmonella, should be avoided. The Centers for Disease Control and Prevention (CDC) provides guidelines for people with weakened immune systems to follow.
Raw and undercooked animal products
This category represents a primary source of foodborne pathogens and should be handled with extreme care or avoided entirely.
- Raw or undercooked meat and poultry: Includes rare steak, sushi, sashimi, and raw or partially cooked sausages.
- Undercooked eggs: This includes soft-boiled eggs, sunny-side-up eggs with a runny yolk, and homemade foods like mayonnaise, hollandaise sauce, or Caesar dressings that use raw eggs.
- Raw or smoked seafood: Raw oysters, mussels, clams, and cold-smoked fish should be avoided. All shellfish and fish must be thoroughly cooked.
Unpasteurized and soft cheeses
Pasteurization is a heat treatment that kills bacteria in milk. Unpasteurized products and certain cheeses carry a higher risk of bacterial contamination.
- Unpasteurized dairy: Avoid any milk or products made from unpasteurized milk, such as some soft ice creams.
- Soft, mold-ripened cheeses: These cheeses can harbor Listeria. Examples include Brie, Camembert, feta, blue cheese, and goat cheese.
Raw produce and deli foods
Even seemingly healthy foods can pose a risk if not prepared properly.
- Raw sprouts: Alfalfa, clover, radish, and mung bean sprouts carry a high risk of bacterial contamination.
- Deli and buffet foods: Pre-prepared cold foods like deli salads, cold cuts, and items from buffets or salad bars should be approached with caution as they are often handled and can be exposed to bacteria.
- Unwashed fruits and vegetables: Always wash and dry fresh fruits and vegetables thoroughly before eating them.
Managing inflammation through diet
Beyond infection risk, a diet focused on reducing inflammation can help manage the symptoms of the autoimmune condition being treated with Enbrel. A diet high in processed foods, sugar, and saturated fats can trigger inflammation, potentially worsening joint pain and other symptoms.
Processed foods, sugar, and refined carbohydrates
These items are linked to increased inflammation in the body and should be limited.
- Processed and red meats: Sausages, bacon, hot dogs, and red meats can increase inflammation.
- Added sugars and sweets: Sugary drinks, candies, and pastries can trigger the release of inflammatory messengers.
- Refined carbohydrates: White bread, white rice, and many baked goods can cause blood sugar spikes and inflammation.
Alcohol and supplements
While there is no known direct interaction, consulting a doctor is crucial regarding these items.
- Alcohol: Excessive alcohol can exacerbate autoimmune conditions like psoriasis and may increase the risk of liver injury. If you are also taking methotrexate alongside Enbrel, limiting or avoiding alcohol is often strongly recommended due to the increased risk of liver damage.
- Grapefruit: Unlike with some other immunosuppressants, there is no evidence of a direct interaction between Enbrel and grapefruit. However, always check with your doctor if you take other medications.
- Herbal supplements: It is essential to discuss all supplements, vitamins, and herbal products with your doctor, as some may have unknown interactions or effects.
Comparison of food safety for Enbrel users
| Food Category | Safer Choice (Recommended) | Higher Risk (Avoid) |
|---|---|---|
| Meat & Poultry | Thoroughly cooked chicken, beef, pork | Rare or undercooked meats, deli meats, cold cuts |
| Eggs | Hard-boiled or well-scrambled eggs | Raw or runny yolks, homemade sauces with raw egg |
| Seafood | Fully cooked fish, shrimp, lobster | Raw sushi, sashimi, raw oysters, smoked fish |
| Dairy | Pasteurized milk, hard cheeses | Unpasteurized milk, soft mold-ripened cheeses (Brie, Feta) |
| Produce | Washed and dried fresh produce | Raw sprouts (alfalfa, radish) |
| Beverages | Water, pasteurized juices, tea | Unpasteurized cider, sugary sodas, excessive alcohol |
| Desserts | Cooked desserts, pasteurized ice cream | Raw cookie dough, soft-serve ice cream |
A note on food preparation
Proper food handling is as important as avoiding certain foods. This includes washing hands and utensils, preventing cross-contamination, and cooking foods to the correct internal temperature. You should also be mindful of your dining choices, opting for restaurants with high sanitation standards and avoiding communal food sources like buffets where food may be left out for extended periods.
Conclusion: Prioritize safety and anti-inflammatory habits
While taking Enbrel, prioritizing food safety is paramount due to the medication's immunosuppressive effects. Avoiding raw and undercooked foods, unpasteurized dairy, and potentially contaminated deli items can significantly reduce your risk of serious foodborne illness. Furthermore, adopting an anti-inflammatory diet that minimizes processed foods, sugar, and excessive alcohol can help support overall health and potentially improve the management of your underlying condition. Always consult your healthcare provider or a registered dietitian for personalized dietary recommendations while on Enbrel or any other medication. The CDC provides further guidance on food safety for those with weakened immune systems.
