March 24th marks World Tuberculosis (TB) Day, a moment to reflect on global efforts to end this devastating disease. At The Noakes Foundation, we are dedicated to advancing evidence-based nutritional interventions that improve health outcomes for those at risk of or who have been diagnosed with TB, particularly when comorbidities such as diabetes, hypertension, and obesity are also present. The World Health Organization (WHO) reports that in 2023, 10.8 million people fell ill with TB, and 1.25 million lost their lives to this disease, which is both preventable and curable. The theme for this year’s World TB Day, “Yes! We can end TB: commit, invest, deliver,” emphasizes the urgency of addressing TB’s health, social, and economic impacts (WHO, 2025).
We are delighted to share that we have received ethical approval to initiate a groundbreaking study at the Dunoon Community Health Centre (CHC), generously funded by the Weissman Foundation. We are deeply grateful for their unwavering support over the years. This study marks the first time we will specifically include participants who are pre-diabetic or diabetic and have been exposed to TB and/or HIV. As an extension of the Eat Better South Africa (EBSA) program, the study aims to investigate how a structured LCHF diet intervention can enhance health outcomes in this vulnerable population. This mixed-method study will involve a 6-week EBSA program focused on nutritional education, aiming to reduce the intake of sugar, refined carbohydrates, and ultra-processed foods while promoting whole foods, healthy fats, and nutrient-dense meals. Participants’ health markers, including blood glucose levels, weight, and immune function, will be monitored before, during, and after the intervention, with additional follow-ups at 6 and 12 months to assess long-term outcomes. An EBSA-trained community coach will facilitate the program to foster trust and ensure the intervention is culturally appropriate and accessible. To gain a deeper understanding, focus groups and interviews will be conducted to explore participants’ experiences, challenges, and perceptions regarding the management of multiple health conditions.
TB continues to be a major public health issue worldwide, but especially in developing countries where poverty, malnutrition, and limited access to healthcare exacerbate its devastating impact (WHO, 2019). Emerging research highlights the significant relationship between metabolic health and TB. Individuals with metabolic disorders, like Type 2 diabetes, are at a higher risk of developing TB due to compromised immune function (Balakrishnan et al., 2011). Conversely, TB can worsen metabolic conditions, making disease management more complex (Kapur & Harries, 2013). Nutrition plays a central role in both the prevention and management of TB. Suboptimal nutrition, combined with poor nutritional choices, weakens the immune system, increasing susceptibility to TB, while TB can exacerbate malnutrition through increased metabolic demands and nutrient malabsorption (Cegielski & McMurray, 2004), highlighting the importance of addressing nutrition. It is well established that dietary interventions with LCHF diets improve metabolic health, reducing insulin resistance, and consequently enhancing immune function (Westman et al., 2007). Therefore, it is likely that LCHF diets could indirectly benefit TB patients.
LCHF diets focus on reducing sugar and refined carbohydrate intake while increasing healthy fats, which together, stabilize blood glucose levels and support overall health. Moreover, essential vitamins such as D, A, and C play crucial roles in immune defense and may be beneficial in managing TB (Martineau et al., 2010; Stephensen, 2001; Vilchèze et al., 2013). Notably, LCHF diets naturally promote higher intakes of critical vitamins and other essential micronutrients. This synergy between nutrient-dense, low-carbohydrate foods and vital micronutrients could further enhance immune resilience and support better TB outcomes.
The intersection of TB, diabetes, and HIV represents a significant health challenge in South Africa. Nutritional interventions that are accessible, culturally sensitive and community-driven are urgently needed. By focusing on dietary education and support, this study aims to empower participants to make sustainable, health-enhancing choices. It will also provide valuable insights into the role and value of LCHF diets in managing complex comorbidities in low-income settings. This study is more than just a research project; it’s a step towards transforming community health through sustainable nutrition. The insights gained will not only benefit the Dunoon community but could also pave the way for broader application of the EBSA program in similar contexts.
We look forward to sharing this study’s outcomes and contributing to the global conversation on TB, nutrition, and holistic health management. Stay tuned for more updates and insights from The Noakes Foundation as we continue to advocate for evidence-based nutrition and health interventions.
References
Balakrishnan, S., et al. (2011). Diabetes mellitus increases the risk of active tuberculosis: A systematic review of 13 observational studies. PLoS Medicine, 8(7).
Cegielski, J. P., & McMurray, D. N. (2004). The relationship between malnutrition and tuberculosis: Evidence from studies in humans and experimental animals. International Journal of Tuberculosis and Lung Disease, 8(3), 286-298.
Kapur, A., & Harries, A. D. (2013). The double burden of diabetes and tuberculosis – Public health implications. Diabetes Research and Clinical Practice, 101(1), 10-19.
Martineau, A. R. (2012). Old wine in new bottles: Vitamin D in the treatment and prevention of tuberculosis. Proceedings of the Nutrition Society, 71(1), 84–89. https://doi.org/10.1017/S0029665111003326
Stephensen, C. B. (2001). Vitamin A, infection, and immune function. Annual Review of Nutrition, 21, 167-192.
Vilchèze, C., Hartman, T., Weinrick, B., & Jacobs, W. R. Jr. (2013). Mycobacterium tuberculosis is extraordinarily sensitive to killing by a vitamin C-induced Fenton reaction. Nature Communications, 4, 1881. https://doi.org/10.1038/ncomms2898
Westman, E. C., et al. (2007). Low-carbohydrate nutrition and metabolism. American Journal of Clinical Nutrition, 86(2), 276-284.
World Health Organization (WHO). (2025). World Tuberculosis Day 2025. Retrieved from https://www.who.int/campaigns/world-tb-day/2025
