Nutrition after Transplant

Getting enough calories and nutrients after transplant is important for recovery. Learn how to manage eating difficulties that may occur.

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Recovering transplant patients can need as much as 50 to 60 percent more calories and twice as much protein in their diets than healthy individuals of similar age and gender.

The high-dose chemotherapy and/or total body irradiation (TBI) given to you prior to transplant severely stresses your body’s organs and tissues. To repair any organ or tissue damage that might occur and to fight fever, you will need to increase your intake of calories and protein.

The calories in food provide the fuel your organs and tissues need to grow and function. Protein-rich foods enable your body to build and repair muscle and body tissue. Vitamins and minerals keep your blood, skin and nervous system functioning properly.

Changing Diet before Transplant

If you are thinking about changing your diet before transplant, ask your doctor for a referral to a registered dietitian who can evaluate the nutritional adequacy of the new diet.

Some diets, such as macrobiotic diets, contain less protein and other nutrients than are needed by a recovering transplant patient.

Quick weight loss is also usually discouraged since you may lose weight while undergoing treatment. Limiting food intake before your transplant could lead to a serious nutrient deficiency.

Using certain herbs, roots or dietary supplements can be dangerous for you while you’re undergoing a transplant. Consult your doctor or dietitian before using these products.

Safe Food Diet

Until your immune system is functioning well, your medical team may put you on a safe food diet to reduce the risk of infection. Foods you may be told to avoid include:

  • raw or under-cooked meat
  • dishes that contain under-cooked meat such as sausages and casseroles
  • raw or under-cooked eggs, or foods that might contain them
  • raw or under-cooked seafood such as sushi
  • raw or unshelled nuts that are not roasted
  • meats and cheese from a deli, unless they are heated prior to eating
  • miso and tempeh products
  • milk products that are not pasteurized
  • cheeses with mold such as blue cheese, Gorgonzola, Roquefort and Stilton
  • soft cheeses such as feta, goat cheese and farmer’s cheese
  • smoked, uncooked refrigerated fish such as nova lox
  • pickled seafood
  • raw honey
  • salad bars and buffets

Some transplant centers include fresh fruits and vegetables on the list of foods to avoid, while others permit them provided they are thoroughly washed.

Mouth and Throat Sores

Mouth and throat sores are common after transplant. They may be caused by chemotherapy, total body irradiation or infection. If mouth sores are a problem for you, try:

  • lukewarm food, rather than hot food
  • cooking foods until tender and soft
  • drinking through a straw to bypass mouth sores
  • high-protein, high-calorie foods to speed healing of the sores such as peanut butter, pasteurized cottage cheese or yogurt
  • a liquid or blenderized diet, or a complete nutrition supplement such as Ensure®, Boost® or Carnation® Instant Breakfast
  • soft foods such as mashed potatoes, cooked eggs, chicken or tuna salad, puddings, soft canned fruit and cooked cereals
  • cold foods such as milk shakes, high-proteinc smoothies, cottage cheese, yogurt, watermelon and slushes
  • soft, frozen foods such as popsicles, frozen yogurt, ice cream and slushes
  • pasteurized fruit nectars and apple or grape juice instead of acidic juices

Food to avoid include:

  • tart or acidic foods such as citrus fruits and juices, pineapple juice and some tomato products
  • strong spices such as peppers, chili powder, nutmeg and cloves
  • coarse foods such as raw vegetables, dry toast, grainy cereals and breads, and crunchy snacks
  • alcoholic beverages and mouthwashes that contain alcohol
  • extremely hot foods or beverages

Ask your doctor for pain medication if discomfort is keeping you from eating.

Dry Mouth

If a dry mouth is making eating difficult, try the following:

  • Add sauces, gravies, broth and dressings to food.
  • Suck on ice chips, popsicles, sugar-free hard candies to keep your mouth moist.
  • Add foods with citric acid to your diet such as oranges, orange juice, lemons, lemonade and sugarless lemon drops, unless you also have mouth sores.
  • Drink liquids with your meals.
  • Ask your dietitian or doctor about saliva substitutes such as Salivart®, Mouth-Kote® and Biotene®.

Avoid eating:

  • meats without sauces
  • bread products, crackers and dry cakes
  • very hot foods and beverages
  • alcoholic beverages and mouthwashes that contain alcohol

Changes in How Food Tastes

Some medications can change the way foods taste, at least for a time. To overcome this problem, Try the following:

  • Eat foods and drink beverages cold or at room temperature.
  • Eat strongly flavored foods such as lasagna or barbecued foods, unless you also have mouth sores.
  • Eat tart or spicy foods, unless you also have mouth sores.
  • Drink fluids with your meal to rinse away any unpleasant taste.
  • Eat protein foods without strong odors such as poultry and dairy products, rather than those with strong odors such as beef and fish.
  • Add flavorful sauces to foods.
  • Eat meat with something sweet, such as cranberry sauce, jelly or applesauce.
  • Try new seasoning combinations to enhance the flavor.

Thick Saliva

 If thick saliva is interfering with your eating, try the following:

  • Drink or gargle with club soda
  • Drink hot tea with lemon.
  • Suck on sugarless sour lemon drops.
  • Eat a lighter breakfast if mucous builds up in the morning, and bigger meals in the afternoon and evening.
  • Rinse frequently with a saline solution of one quart water, 1/2-to-3/4 teaspoon of salt and one-to-two teaspoons of baking soda.
  • Drink lots of fluids.
  • Eat soft, tender foods such as cooked fish and chicken, eggs, noodles, thinned cereals, and blenderized fruits and vegetables diluted to a thin consistency.
  • Eat small, frequent meals
  • Drink diluted juices, broth-based soups and fruit flavored beverages
  • Try a liquid diet if the problem is severe.

Avoid eating:

  • meats that require chewing
  • bread products
  • fried foods
  • thick cream soups
  • thick hot cereals
  • nectars

If food has a metallic taste, try using plastic eating utensils and avoid eating canned foods and beverages.

Nausea and Vomiting

If nausea is interfering with your ability to eat, try eating:

  • small frequent meals
  • dry crackers or toast, especially before movements like getting out of bed, unless you also have mouth sores
  • cold foods, rather than warm foods, because they tend to have less odor
  • low-fat foods like cooked vegetables, canned fruit, baked skinless chicken, sherbet, fruit ice, popsicles, gelatin, pretzels, vanilla wafers and angel food cake
  • clear, cool beverages, sipped slowly through a straw frequently throughout the day
  • gelatin, popsicles and ice cubes made of a favorite liquid

If you are hospitalized you can:

  • request anti-nausea medication 30 minutes before your meal
  • ask that food trays be brought to you without covers on the plates to avoid being overwhelmed by the smell when the cover is removed

Avoid eating:

  • spicy foods
  • foods that are overly sweet
  • strong smelling foods
  • foods that are high in fat
  • hot liquids with meals
  • drinking liquids on an empty stomach
  • lying flat on your back after eating. Instead, sit or recline with head elevated.

Keep food in kitchen areas and leave the kitchen if you feel queasy. Avoid lying flat on your back after eating as this can make nausea worse. If you need rest, sit or recline with your head elevated.

Your doctor can also prescribe a medication to help control your nausea.

Lack of Appetite/Weight Loss

If you have a poor appetite or are experiencing unplanned weight loss try eating:

  • small, frequent high-calorie meals
  • high-nutrient liquids like juice or milk, instead of low-calorie drinks like coffee, tea and diet soda
  • nutrient-dense, high-calorie foods like:
    • pasteurized cheese, whole milk, and ice cream
    • eggs
    • avocados
    • olives
    • Greek yogurt
    • hummus
    • trail mix
    • fruit smoothies
    • protein powder added to food or drinks
    • dried fruit
    • peanut butter
    • wheat germ
    • nuts
    • fruits
  •  complete nutrition supplements such as Ensure®, Boost®, Carnation Instant Breakfast® or Enu®, provided they have been approved by your dietitian
  • adding dry milk powder to casseroles and cooked cereals

You can also try:

  • light exercise before meals to increase your appetite
  • creating a pleasant meal time atmosphere eg. colorful place settings, varied food colors and textures, and soft music
  • asking your doctor about oral medications that may improve your appetite

Diarrhea

If you are experiencing diarrhea after transplant try eating or drinking:

  • smaller amounts of food at each meal
  • extra fluids to prevent dehydration
  • drinking fluids between meals, rather than with meals
  • foods and beverages that are high in potassium such as:
    • ripe bananas
    • potatoes without the skin
    • Gatorade®, Pedialyte®, Powerade®  and pasteurized peach and pear nectar
    • baked fish, chicken and ground beef
    • well cooked eggs
    • well-cooked vegetables (but not beans, broccoli, cauliflower or cabbage)
    • canned fruit
    • white rice
    • white bread

Avoid eating:

  • bran, whole grain cereals and breads
  • raw vegetables
  • fruits with skin and seeds
  • popcorn. seeds and nuts
  • carbonated beverages
  • beans, broccoli, cauliflower and cabbage
  • chewing gum
  • spicy foods
  • foods with rich gravies or sauces
  • foods and drinks with caffeine such as coffee, tea, chocolate, colas and other caffeinated soft drinks
  • dairy products unless they are treated with Lactaid®
  • garlic supplements (fresh garlic is fine)
  • Gingko bilboa

Do not take over-the-counter medications like Imodium® without first consulting your doctor. If you have a colon infection, these drugs can sometimes make the infection worse.

Constipation

If you are experiencing constipation try:

  • drinking warm beverages, rather than cold ones
  • eating high-fiber foods such as
    • well washed raw fruits and vegetables
    • whole wheat breads and cereals
    • dried fruit
    • cooked dried peas and beans
  • light exercise
  • drinking warm prune juice or eating stewed prunes

Your doctor may be able to prescribe medication if the constipation persists for more than a day or two.

Herbs, Botanicals and Supplements

Until your immune system has fully recovered, you should avoid taking any herbal or botanical product without your doctor’s approval.

Some of these products can:

  • interfere with chemotherapy
  • interact badly with other drugs you are taking
  • cause a serious infection due to inadequate purification of the product or extra ingredients added to it
  • damage your liver, kidneys or other organs
  •  make gastrointestinal problems worse
  • • interfere with blood clotting

While recovering from transplant, avoid taking:

  • Alfalfa
  • Borage
  • Chaparral
  • Chinese herbs
  • Coltsfoot
  • Comfrey
  • DHEA
  • Dieter’s Tea (including senna, aloe, rhubarb root, buckthorn, cascara, castor oil)
  • Ephedra or Mahuange
  • Groundsel or Life Root
  • Heliotrope or Valerian
  • Kava Kava
  • Laetrile (Apricot Pits)
  • Licorice Root
  • Lobelia
  • L-tryptophan
  • Maté Tea
  • Pau d’Arco
  • Pennyroyal
  • Sassafras
  • St. John’s Wort
  • Yohimbe and Yohimbine

If your platelet count is low, you should avoid garlic pill supplements (cooking with regular garlic is fine) and gingko biloba, which can interfere with blood clotting.

Fad Diets

New diets that purport to improve health, help you shed weight or boost the immune system pop up daily. If you are considering trying one of these diets while recovering from transplant, check with your doctor and dietitian first to be sure it will provide you with the calories, protein and nutrients you need for recovery. 

Watch a video about optimizing your nutrition after transplant

Helpful Resources

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Updated June 2024

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