Biologics are a class of advanced medications, typically composed of proteins or antibodies, that are designed to target and modify specific components of the immune system. These therapies are frequently used to treat autoimmune conditions, such as rheumatoid arthritis, inflammatory bowel disease, and psoriasis, by calming the body’s overactive immune response. Because biologics function by partially suppressing or altering immune pathways, a primary consequence is a heightened susceptibility to infections, including those transmitted through food. The main dietary concern for individuals on these medications is avoiding common foodborne pathogens like Listeria monocytogenes, Salmonella, and Escherichia coli.
High-Risk Foods Requiring Complete Avoidance
Patients must practice strict avoidance of raw or undercooked animal proteins, as heat is the most effective method for pathogen elimination. This includes rare or medium-rare meats, poultry, and dishes containing raw eggs, such as homemade mayonnaise or Caesar dressing, which may carry Salmonella. Raw seafood poses a similar threat; fish found in sushi, oysters, or ceviche must be strictly avoided due to the potential for parasites and bacteria.
Unpasteurized dairy products are high-risk because they have not undergone the heat process that kills harmful bacteria like Listeria. This category includes raw milk and soft cheeses made from unpasteurized milk. Furthermore, all mold-ripened soft cheeses and blue cheeses should be avoided, regardless of pasteurization status, as their higher moisture content and lower acidity favor Listeria growth.
Deli meats, cold cuts, and hot dogs can sometimes be contaminated with Listeria after processing, so they must be reheated to 165°F before consumption. Refrigerated pâtés and meat spreads should be avoided, though canned or shelf-stable versions are acceptable once opened. Raw vegetable sprouts, such as alfalfa or clover sprouts, are unsafe because they have been linked to numerous outbreaks of Salmonella and E. coli due to contamination during the growing process.
Dietary Items That Can Affect Drug Efficacy
Beyond infection risk, certain foods and substances can interact with the medication itself, potentially altering its concentration or exacerbating side effects. Alcohol consumption is a concern because many biologics are metabolized by or affect the liver. Combining alcohol, a known liver stressor, with these medications can increase the risk of liver damage. Alcohol intake may also intensify common medication side effects, such as drowsiness or dizziness, and reduce the drug’s overall efficacy.
Grapefruit and grapefruit juice are known to interact with numerous prescription drugs, including certain immunosuppressive medications. The fruit contains natural compounds that inhibit a key metabolic enzyme in the gut and liver (CYP3A4). When this enzyme is blocked, the drug is metabolized more slowly, leading to a higher concentration in the bloodstream. This spike in concentration can increase the risk of side effects or even lead to drug toxicity.
Patients should exercise caution with high-dose herbal supplements, especially those marketed as “immune boosters.” These supplements are designed to activate immune cells and stimulate the production of cytokines. For someone taking a biologic to suppress an overactive immune system, introducing an immune-stimulating product can counteract the drug’s therapeutic effect. This unpredictable immune modulation can potentially trigger a disease flare or interfere with the biologic’s intended mechanism of action. Patients should consult with their prescribing physician or pharmacist before introducing any new supplement into their regimen.
Safe Food Preparation and Consumption Guidelines
Minimizing the risk of foodborne illness relies heavily on applying strict food safety principles in the kitchen: Clean, Separate, Cook, and Chill. The first step involves rigorous handwashing with soap and water for at least 20 seconds before and after handling food, particularly raw meat or unwashed produce. Kitchen surfaces, utensils, and cutting boards must also be thoroughly cleaned and sanitized to prevent the transfer of bacteria.
To avoid cross-contamination, raw meat, poultry, and seafood must be kept separate from ready-to-eat foods like fruits and vegetables. Using distinct cutting boards for raw ingredients and fresh produce is highly recommended. Raw items should be stored on the lowest shelf in the refrigerator to prevent juices from dripping onto other foods. All produce, even pre-washed salads, should be rinsed under running water before use.
The cooking step requires using a food thermometer to ensure all proteins reach a safe minimum internal temperature to destroy pathogens. For instance, all poultry and reheated leftovers should reach 165°F, while ground meats should be cooked to 160°F. The final principle, Chill, requires perishable foods to be refrigerated promptly, ideally within two hours of cooking. Leftovers should be stored in shallow containers for rapid cooling and consumed within three to four days.