Nutrition and Eating Difficulties

Recovering transplant patients require as much as 50-60% more calories and twice as much protein in their diet 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, 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.

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, 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 before 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 cheeses unless they are cooked
• 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. If you have mouth sores, try:

• lukewarm food, rather than hot food
• cooking food until tender and soft
• drinking through a straw to bypass mouth sores
• high-protein, high-calorie foods such as peanut butter, pasteurized cottage cheese, or yogurt
• a liquid or blenderized diet, or an oral nutrition supplement such as Ensure®, Boost®, or Carnation® Instant Breakfast
• soft foods such as mashed potatoes, cooked eggs, chicken or tuna salad, puddings, gelatin, canned fruit, cooked cereals, and pasteurized eggnog
• cold foods such as milkshakes, high-protein smoothies, cottage cheese, yogurt, and watermelon
• 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 you should avoid:

• tart or acidic foods and beverages such as citrus fruits and juices, pineapple juice, and some tomato products
• salty foods
• 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, or 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 using a commercial saliva substitute such as Salivart®, Mouth-Kote®, or 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 eating or drinking:

• foods and beverages cold or at room temperature rather than hot
• 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 unpleasant taste
• high-protein foods that don't have a strong odor, such as poultry and dairy products, rather than those with strong odors, such as beef and fish
• add flavorful sauces to food
• meat with something sweet, such as cranberry sauce, jelly, or applesauce.
• new seasoning combinations to enhance the flavor

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

Thick Saliva

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

• Drink or gargle with club soda (seltzer).
• 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

Nausea

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 liquids, flavored gelatin, popsicles, and ice cubes made of a favorite liquid
• small amounts of liquid sipped slowly through a straw frequently throughout the day

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

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 
• protein supplements such as Ensure®, Boost®, and Carnation Instant Breakfast®, provided they have been approved by your dietitian
• dry milk powder added to casseroles and cooked cereals

You can also try:

• light exercise before meals to increase your appetite
• creating a pleasant mealtime atmosphere e.g. colorful place settings, varied food colors and textures, and soft music

Ask 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
• 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 vegetables (but not beans, broccoli, cauliflower or cabbage)
  • canned fruit

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 that contain 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)
• Ginkgo biloba

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:

• drink warm beverages rather than cold ones
• eat high-fiber foods such as
  • well washed raw fruits and vegetables
  • whole wheat breads and cereals
  • dried fruit
  • cooked dried peas and beans

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 herb, botanical, or supplement without your doctor’s approval. Some of these products can:

• interfere with chemotherapy
• interact 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 ginkgo 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 the diet will provide you with the calories, protein, and nutrients you need for recovery.

Helpful Resources

• NMDP: Read more about food safety. 
• Cook For Your Life: Get useful tips for healthy eating during and after transplant.
• Memorial Sloan Kettering Cancer Center: Learn more about herbs, supplements, and botanicals

Next Page: GVHD after Transplant