After you return home and throughout your recovery, it is important to get enough calories.
Recovering transplant patients need 50 to 60 percent more calories and twice as much protein in their diets than healthy individuals of similar age and gender.
This increase in caloric and protein intake will help you fight infection and repair any tissue damage caused by your transplant. You may need to stick to this diet for several months.
Getting enough calories, protein and fluids into your body can be difficult, particularly during the first few weeks after transplant. Problems such as:
- mouth sores
- nausea and vomiting
- dry mouth
- changes in taste
can make mealtimes a chore, rather than a pleasure. Certain medications can also cause a loss of appetite.
Below are suggestions for managing some common problems after transplant that may make it difficult for you to eat.
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:
- foods that are lukewarm or cold, rather than hot
- foods cooked until tender and soft, adding sauces to moisten them
- drinking through a straw to bypass mouth sores
- high-protein, high-calorie foods to speed healing of the sores
- a liquid or blenderized diet, or a complete nutrition supplement such as Ensure®, Boost® or Carnation® Instant Breakfast
- soft foods such as creamed soups, pasteurized cheeses, mashed potatoes, cooked eggs, custards, puddings, gelatin, soft canned fruit, cooked cereals and pasteurized eggnog
- soft, cold foods such as milk shakes, ice cream, cottage cheese, yogurt, slushes and watermelon
- pasteurized fruit nectars and fruit flavored beverages instead of acidic juices
Food you should avoid:
- tart or acidic foods such as citrus fruits and juices, pineapple juice and some tomato products
- salty foods, including broth
- strong spices such as peppers, chili powder, nutmeg and cloves
- coarse foods such as raw fruits and vegetables, dry toast, grainy cereals and breads, and crunchy snacks
- alcoholic beverages and mouthwashes that contain alcohol
Ask your doctor for pain medication if discomfort is keeping you from eat.
Practice good mouth and dental care. Rinse often with 1 cup water, 1/4 ts baking soda nd 1/8 tsp salt.
Dry mouth is a common side effect of total body irradiation, nausea medications, and antihistamines. If a dry mouth is making eating difficult, try the following:
- Add sauces, gravies, broth and dressings to food.
- Suck on ice chips, popsicles, sugarless gum or hard candies to keep your mouth moist.
- Add citric acid to your diet to stimulate saliva, unless you also have mouth sores. Citric acid is in oranges, lemons, and sugarless lemon drops.
- Drink clear liquids with and between meals.
- Practice good mouth and dental care to decrease the risk of infection.
- Ask your dietitian or doctor about saliva substitutes such as Salivart®, ®Mouth-Kote and Biotene®.
- 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
Total body irradiation, chemotherapy, pain medications and antibiotics can make foods you normally enjoy taste unpleasant. To overcome this problem, try:
- cold foods and beverages
- strongly flavored foods such as chocolate, lasagna, spaghetti or barbecued foods, unless you also have mouth sores
- tart or spicy foods, unless you also have mouth sores
- fluids with your meal to rinse away any bad taste
- protein foods without strong odors such as poultry and dairy products, rather than those with strong odors such as beef and fish
- sauces with foods
- meats with something sweet, such as cranberry sauce, jelly or applesauce
- new combinations of seasonings or adding sugar or salt to enhance the flavor
If food has a metallic taste, try using plastic eating utensils.
Total body irradiation and dehydration can cause thick saliva. If thick saliva is interfering with your eating, try the following:
- Drink club soda or 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 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
- Eat moist fruits like melons
- Try a liquid diet if the problem is severe.
- meats that require chewing
- bread products
- oily foods
- thick cream soups
- thick hot cereals
Nausea and Vomiting
High-dose chemotherapy, total body irradiation, infections and drugs used to control them, opioid medications, interferon and mucous drainage from your mouth and sinuses can trigger 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
- pretzels, vanilla wafers and angel food cake
- 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
- 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
- perfumes and other strong scents
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 are nauseated, don't lie flat on your back after eating. This can make the problem 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
Many people experience lack of appetite and weight loss after transplant. If you have a poor appetite 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
- Greek yogurt
- trail mix
- fruit smoothies
- protein powder
- dried fruit
- peanut butter
- wheat germ
- protein supplements such as Promod® or Unjury®
- 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, soft music, etc.
- working with a healthcare professional to address any sadness you are feeling that might be affecting your appetite
- asking your doctor about oral medications that may improve your appetite
Total body irradiation, infections, lactose intolerance and some medications such as antibiotics can cause diarrhea. Try eating:
- 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
- tomato juice, Gatorade®, Pedialyte®, Powerade® orange juice, 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
- bran or 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®
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.
Chemotherapy, some opioid pain medications and some anti-nausea drugs can cause constipation. Try:
- drinking warm beverages
- eating high-fiber foods such as
- well washed raw fruits and vegetables
- whole wheat breads and cereals
- dried fruit
- 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.
Neutropenic and Food Safety Diets
Until your immune system is functioning well, your medical team may put you on a neutropenic or food safety diet to reduce the risk of infection. Food items you may be told to avoid may include:
- raw or undercooked meat
- dishes that may contain undercooked meat such as sausages or casseroles
- raw or undercooked eggs or foods that might contain them
- raw or undercooked seafood such as sushi
- raw nuts or unshelled nuts
- miso and tempeh products
- non-pasteurized milk products and juices, kombucha and other unpasteurized drinks
- cheeses with mold
- soft cheeses such as brie or feta
- Mexican style oft cheeses, such as queso fresco and queso blanco, which are often made with unpasteurized milk
- meats and cheeses from a deli
- 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.
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:
- reduce the effectiveness of other drugs you are taking
- cause a serious infection due to inadequate purification of the product or extra ingredients it contains
- damage your liver, kidneys or other organs
- make gastrointestinal problems worse
- interfere with blood clotting
Herbal and botanical products to avoid while your immune system is recovering include:
- Chinese herbs
- 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
- Maté Tea
- Pau d’arco
- 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.
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.