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Second Wind Lung Transplant Association

Healthy Eating for Transplant Recipients

Immediately after transplant your nutritional needs will be increased due to the stress of surgery and the side effects of some medications. For this reason, you may need to make adjustments in your diet. For example, a common side effect of Prednisone is an increased appetite and cravings for salts or sweets that results in weight gain. Even though the diet after transplantation is often less restrictive than before surgery, a healthy eating plan can make the difference in your long-term health and the health of your transplanted organ.

The following recommendations comply with the American Heart Association, the American Dietetic Association and the American Diabetes Association guidelines.

Adequate Nutrition

A balanced diet is important after surgery to replace vitamin and mineral losses and provide enough protein and calories to promote healing. Those who have lost weight and or had a poor appetite before surgery should concentrate on improving their bodies’ nutrient stores.

  • Poultry, seafood, lean red meats, and low fat dairy products are good protein source.
  • Include high fiber foods such as fresh fruits and vegetables, whole grain breads and cereals, and bran.
  • Eat enough servings from each of the four basic food groups to assure a well balanced diet. From the meat/protein food group; 2 servings for adults, 2 servings for teenagers, and 2 servings for children.
    • From the breads/cereals food group; 4 servings for adults, 4 – 6 servings for teenagers, and 4 servings for children.
    • From the milk/dairy food group; 2 servings for adults, 4 servings for teenagers, and 3 servings for children.
    • From the vegetables/fruit food group; 4 – 6 servings for adults, 4 – 6 for teenagers, and 4 servings for children.

Cholesterol and Saturated Fats

Cholesterol is a fat-like substance that the body needs to function properly. Our bodies produce cholesterol in the liver and we also get cholesterol from the animal products we eat. Vegetable products do not contain cholesterol. Because cholesterol is a fat-like substance, it needs help to move through the watery membranes of the body. High density lipoproteins (HDL) carry the cholesterol from the arteries to the colon where it is eliminated through waste. Low density lipoproteins (LDL) carry cholesterol to body tissues where it is deposited. LDLs are sticky and can attach themselves to the walls of the blood vessels, producing a build-up of plaque over the years. This accumulation makes the path for blood flow smaller and smaller. When the pathway becomes blocked, we experience a stroke or a heart attack. This is the type of cholesterol we need to watch.

After transplantation many people tend to have high blood cholesterol levels partially due to their medications. Studies confirm that over 40% of transplant recipients have elevated cholesterol and triglyceride levels which may cause heart disease. Avoiding excessive dietary cholesterol and saturated fat intake and too much weight gain can help to control blood cholesterol levels. After your transplant, your blood cholesterol level should be measured frequently. The ideal goal is under 200mg/dl. 130 to 159mg/dl is borderline high. And 160mg/dl and above is considered too high.

Blood cholesterol levels can be reduced by making specific changes in the amount and type of food eaten. The dietary changes include decreasing the total amount of fat, saturated fat and cholesterol. Increased consumption of fiber in the form of fresh fruits and vegetables, whole grains and legumes (dried beans and peas) and nuts is recommended. If you are overweight, weight loss is also encouraged. Experts recommend eating no more than 300 milligrams of cholesterol a day.

Saturated fats are found in animal and dairy products and some plant products. These fats are usually hard at room temperature. They include coconut oil, palm oil and cocoa butter. They tend to raise blood cholesterol levels. Polyunsaturated fats are found in plant products and are liquid at room temperature. Oils such as safflower, sunflower, corn and soybean are high in polyunsaturated fat. These fats tend to lower blood cholesterol. Monounsaturated fats, such as olive oil, canola oil, and peanut oil, may lower cholesterol levels.

  • Avoid foods that contain palm oil, palm kernel oil, coconut oil, lard, beef tallow, hydrogenated or partially hydrogenated vegetable shortening, butter, cream, and cocoa butter.
  • Limit egg yolks to 3 – 4 per week (including foods containing eggs).
  • Choose seafood and poultry more often than beef, lamb, pork, or cheese. Remove poultry skin.
  • Avoid organ meats and fatty meats such as cold cuts, sausage, bacon and fried foods.
  • Choose 1% low fat or skim milk.
  • Choose low fat cheese.
  • Use soft margarine in limited amounts instead of butter.
  • Avoid gravy and cream sauces.
  • Use broth to moisten meat.
  • Exercise.

Sodium

Sodium is a mineral that is essential for many normal body functions as it acts with water to maintain fluid balance and to help regulate blood pressure. It also helps to regulate the amount of fluid found between and inside cells, to coordinate muscle contractions, expedites nerve impulses, and helps to maintain the acid-base balance (pH) of the blood. However, your body requires much less sodium than the average American consumes daily. High blood pressure and fluid retention often occur as side effects of the medications taken after transplantation. Reducing the amount of sodium consumed may help people control blood pressure and minimize sodium and fluid retention. A mild sodium (salt) restriction is recommended (2,400 mg or 2.4 grams of sodium per day). This is equivalent to roughly one teaspoon of table salt. People with hypertension who are also sodium-sensitive may require even smaller sodium intakes (usually about 2,000 mg daily) to keep blood pressure as low as possible.

  • Use herbs and spices to flavor foods.
  • Avoid table salt and salt substitutes, which still may contain a small amount of sodium..
  • Avoid foods with visible salt such as potato chips and crackers.
  • Avoid salted, smoked, cured, pickled or canned meat, poultry or fish.
  • Avoid cold cuts, sausage, bacon, hotdogs, anchovies, sardines, ham, regular canned tuna and salmon, breaded fish, regular cheese and cheese spreads, pickles, vinegars, regular peanut butter, and canned soups, all of which are high in salt.
  • Shop carefully for canned and processed foods. Check the list of ingredients on the label. All ingredients are placed in order of the highest percentage of content listed first. Many of the so-called “healthy choices” are not low salt or as low salt as they claim.
  • Look out for foods that contain sodium chloride, acetate, ascorbate, benzoate, bicarbonate, citrate, fumarate, glutamate (including monsodium gluutamate or MSG), nitrate, nitrite, and oleate.
  • When buying frozen vegetables, most of the greens have been blanched in boiling salt water to help preserve them. Rinse before cooking.
  • If you cook with wine, don’t use cooking wines, they are loaded with salt. Instead use real wines.
  • Eat fresh, unprocessed foods whenever possible.
  • Leave out salt in cooking and baking wherever possible.
  • Check the sodium content of prescription drugs and read the labels of over-the-counter medications, since both may contain significant amounts of sodium.

Sweets

Immediately after your transplant high doses of steroid medications are given. This mediation affects the way your body uses sugar. In order to prevent high blood sugar (hyperglycemia), a diet low in concentrated sweets is recommended. This diet will help keep your blood sugar at a normal levels and help prevent unwanted weight gain.If high blood sugar becomes a long term problem, a diabetic diet with a set meal plan may be ordered by your doctor.

  • Foods to avoid in excess.
    • Candy, cookies, pie, cake, ice cream, sugar sweetened beverages, soda, lemonade, iced tea, Kool Aid, sugar, honey, canned fruit in syrup, fruit yogurt made with sugar, syrup, jelly, jam

Fiber

Eating a high fiber diet is important to your nutritional program. High fiber foods help to lower cholesterol, maintain normal bowel function, and may help reduce blood sugar. Most American consume inadequate fiber. Experts recommend between 20 – 35 grams of fiber a day as a healthy guideline.

There are two types of fiber, insoluble and soluble. Insoluble fiber includes foods like wheat bran, whole grain breads, bran cereals, and vegetables (especially root vegetables). They help prevent constipation, and provide a feeling of fullness. They also can prevent colon cancer. Soluble fiber include foods like oat bran, oatmeal, citrus fruit, apples, strawberries, beans and barley. They help lower blood cholesterol and may decrease blood sugar.

General Guidelines for a Healthy Diet

Registered dieticians are usually available to you as part of the transplant teams. They can help you plan your diet to meet your specific needs and tastes. A few simple changes in your eating habits can make a difference in your long-term health and the health of your transplant. Since this is a healthy way to eat for the whole family, there is no need to prepare separate meals.

For meat and protein-rich foods, choose:

  • Fresh fish, chicken and turkey without skin
  • Ground turkey Lean, well-trimmed beef, veal, lamb, pork
  • Dried beans, lentils, peas, tofu
  • Egg whites or cholesterol-free egg powder
  • Water-packed tuna Low-fat, low-sodium frozen dinners

Limit or Avoid:

  • Fried chicken, duck
  • Fatty cuts of meat
  • Bacon, sausage, lunch meats, frankfurters
  • Liver and other organ meats
  • Cured and smoked meats, and fish
  • Egg yolks (3 per week)
  • Canned meats and fish Regular frozen dinners

For breads and cereals, choose:

  • Plain breads, English muffins, bagels
  • Plain pasta and rice
  • Hot or cold cereals with no or minimal added fat, sugar or salt
  • Low-fat, low-salt snack foods – unsalted pretzels, air-popped popcorn, Scandinavian flatbread crackers, rice cakes, melba toast
  • Low-fat, low-salt baked goods – angel food cake, graham crackers, fruit cookies, gingersnaps, fortune cookies

Limit or Avoid:

  • High-fat, high-sugar baked goods – Danish pastry, croissants, etc.
  • Granolas with coconut or coconut added
  • Salted chips, cheeses, or butter crackers
  • Seasoned pasta and rice mixes

For milk, cheese and dairy products, choose:

  • Skim or 1% milk
  • Evaporated skim milk, or nonfat dry milk powder
  • Low-fat or nonfat yogurt
  • Low-fat, low-salt cheeses

Limit or Avoid:

  • Any milk containing more than 1% fat
  • Cream, half & half, nondairy creamers
  • Whipped cream, nondairy whipped toppings
  • Whole-milk yogurt, sour cream, and cheeses

For fruits and vegetables, choose:

  • Several servings a day with plenty of variety
  • All fresh and sundried fruits
  • All fruit juices (preferably unsweetened) (Watch grapefruit juice with certain medications)
  • Raw or frozen vegetables prepared without fat or salt
  • Homemade or low-sodium canned soups, bouillons, and broths
  • Low-sodium vegetable juices

Limit or Avoid:

  • Coconut and coconut meat or juice
  • Deep-fat fried or canned vegetables
  • Vegetables with cream, cheese, or butter sauces
  • Packaged sauces and casseroles
  • Regular soups, bouillions, and broths
  • Pickles and olives

For fat, choose:

  • Un-salted margarine or diet margarine made with liquid safflower, corn, or sunflower oil
  • Vegetable oils
  • Low- fat diet salad dressings made without saturated oils
  • Reduced-calorie mayonnaise or limited amounts of regular mayonnaise
  • Cook with oils which are low in unsaturated fats, such as olive oil or canola oil

Limit or Avoid:

  • Butter or margarines made with partially hydrogenated oil
  • Foods containing salt pork, lard, meat fat, hydrogenated or partially hydrogenated solid vegetable shortening; products made with coconut or palm oil
  • Regular salad dressings and those made with sour cream or cheese
  • Salted nut snacks
  • Peanut butter

For sweets, choose:

  • Fruit ices, gelatin, sherbets, low-fat frozen yogurt, ice milk
  • Desserts prepared with low-fat ingredients and little salt

Limit or Avoid:

  • Ice cream
  • Chocolate
  • Doughnuts, pastries, cakes, cookies, and pies unless prepared to be low-fat and low salt

Weight Control

Weight gain after transplantation is commonly due to steroid treatments, which greatly increase your appetite. You can successfully control your weight by limiting the amount of high calorie foods you eat and gradually increasing your physical activity to burn off calories.

If you are not sure your weight is healthy, ask your doctor. He or she can determine if your weight is a good one for you, depending on your body build, how much of your weight is fat, where your excess weight is located, your family history of medical problems, and your personal history of any weight-related health problems (such as high blood pressure).

Set out to lose weight slowly. A weight loss of 1/2 to 1 pound per week is generally considered a safe goal. Avoid yo-yo dieting (losing and gaining weight over and over), which can permanently slow down your metabolism and increase the fat stores on your body, making it even more difficult to lose weight. Eat regularly. Skipping meals may increase your appetite further or slow down your metabolism. Include exercise in your program. Regular exercise helps you lose pounds and control weight – thus indirectly helping to reduce your blood pressure – but it also reduces your risk of many other diseases.

  • Limit fats such as margarine, gravy, cream, oil, mayonnaise, salad dressing, and fried foods.
  • Limit intake of high-sugar sweets such as candy, cookies, cakes, and regular sodas.Try fruits or popsicles for dessert.
  • Limit foods that contain sucrose, brown sugar, raw sugar, glucose, dextrose, fructose, maltose, lactose, honey, syrup, corn sweetener, high-fructose corn syrup, molasses, and fruit juice concentrate.
  • Limit portions – no second helpings. Select only one entree. Add a salad or vegetable if you are hungry. Eat slowly and eat a variety of foods.
  • Drink plenty of water and low calorie beverages. Limit high calorie beverages between meals (soda, Kool Aid, sweetened juices).
  • Trim all visible fat from meat including skin from poultry.
  • Avoid frying meats. Instead roast, bake or broil meats.
  • Steam or stir-fry vegetables in acceptable oils.
  • Avoid using whole eggs in recipes. Instead, replace with 2 egg whites for 1 egg, or use 1/4 cup of egg substitute for 1 egg.
  • Use applesauce in baked goods instead of oil or butter. 1 cup applesauce equals 1 cup oil/butter.
  • Replace low-fat for whole versions of yogurt, ice cream, sour cream, cheese and milk.
  • Limit fat intake to 30% or less of calories per day. Fat contains approximately nine calories per gram, which is why high-fat foods are also high-calorie foods. By contrast, protein and carbohydrate supply only four calories per gram. To calculate the percentage of calories from fat, multiply the number of grams of fat by 9, then divide by the number of calories per portion.
  • Limit achohol intake to no more than two ounces of liquor, eight ounces of wine, or 24 ounces of beer a day if you’re a man, and 1.5 ounces of liquor, five ounces of wine, or 12 ounces of beer a day if you’re a woman.

Calcium

Steroids (Prednisone, Solumedrol or Decadron) may cause bones to lose calcium, particularly if dietary calcium intake is inadequate. Osteoporosis is a common consequence of long-term steroid use. Dairy products are the main sources of calcium and should be included in the diet to help keep bones strong.

Your daily calcium needs change as you age. From birth to 6 months, you need 400 mg/day. From 6 months to 1 year, you need 600mg. From 1 year to 5, you need 800mg. From age 6 to 10, you need 800 to 1,200mg. From 11 to 24, you need 1,200 to 1,500mg. Pregnant or lactating women need 2,000 mg. Women 25 to 50 need 1,000mg. Men 25 – 65 need 1,000mg. Post-menopausal women need 1,500 mg if they are not taking estrogen, and 1,000 mg if they are. Women and men over 65 need 1,500 mg.

For transplant recipients it’s generally accepted that you need 1,500 mg per/day through your diet and/or supplements. In addition you need to take 400 – 800 IU of vitamin D supplements, which help the body absorb calcium. However 30 – 60 minutes of sunshine weekly will provide enough vitamin D. Not all calcium supplements are readily absorbable. Those that are most easily used by the body contain calcium carbonate. Newer products contain calcium with citrate and malate, acids that help the body absorb calcium. Check the label or dissolve a tablet in four ounces of white wine vinegar and stir. If it dissolves in half an hour, it’s fine; if not, switch brands. Beware of dolomite and bone meal sources of calcium – some brands may be contaminated with lead.

  • Choose at least two servings of low-fat dairy products per day, such as two eight ounce glasses of 1% low fat or skim milk. An 8 – ounce glass of milk contains 300 mg of calcium.
  • Eat a healthy, balanced diet. Salt and excess protein and phosphorus (contained in meat) increase the loss of calcium in urine. Too much fiber reduces the amount of calcium that can be absorbed.
  • Don’t drink caffeine. This causes calcium to be secreted into the urine.
  • Avoid alcohol. As much as two drinks per day have been shown to keep the body from properly absorbing calcium and other minerals.
  • Don’t smoke. Smoking interferes with estrogen activity, including estrogen replacement therapy, and can cause menopause to arrive at least 5 years earlier than normal. Additionally, studies indicate that cadmium, a heavy metal found in cigarette smoke, can cause extensive bone loss.
  • Exercise to work your bones and help to build bone mass. Regular activity is vital to preventing bone loss.

Potassium

Potassium is a substance the body uses to control nerve and muscle function, including heart function. Cyclosporine may cause an increase in serum potassium. The amount of potassium which is allowed in your diet depends on your dialysis and remaining kidney function. The following foods are high in potassium and may need to be avoided after transplantation.

  • High Sources of Potassium:
    • avocado, molasses, flounder, halibut, tomato juice, lima beans, black eyed peas, kidney beans, lentils, split peas lima beans, pinto beans, potatos, winter squash, yams, bran cereal, beet greens, bananas, mushrooms, sardines honeydew melon, plantain, prune juice, spinach, tomatoes, artichokes, nuts, skim milk, whole milk, dried apricots cucumber, sweet potatoes.