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Diet After a Kidney Transplant

Do I need to be on special diet after my transplant?

After your kidney transplant, your diet will still play a large role. As your body adjusts to your new kidney, you may need to make food choices to keep your kidney healthy. If you were on dialysis before you had your transplant, you may find that this diet is easier to follow than the one you followed when on dialysis.

Will my medications affect my diet?

Your diet will be affected by the use of medications necessary to prevent rejection of your transplant. Some common anti-rejection medications and their side effects are:

Mycophenolate mofetil (Cellcept) may cause diarrhea, constipation, nausea, and vomiting. Small frequent meals may be better tolerated than three large meals.

Tacrolimus (Prograf) may cause increased blood sugar levels and/or nausea and diarrhea.

Cyclosporin (Neoral, Sandimumune, Gengraf) may cause potassium retention and increase potassium levels in the blood. Cyclosporin can also contribute to increased blood fat levels (cholesterol and triglycerides) and increased blood pressure.

Azathioprine (Imuran) may cause nausea and vomiting. It is recommended that this medication be taken with food. Small frequent meals may be better tolerated than three large meals.

Steroids (Prednisone) may cause an increase in appetite (and unwanted weight gain), blood fats (cholesterol and triglyceride), blood sugar, and/or blood pressure.

Other common medications may also increase your blood fats (cholesterol and triglycerides), blood sugar, and/or blood pressure. Changes in potassium, magnesium, and phosphorus levels are also common. These may return to normal as the doctor lowers the amount of medication you need to prevent rejection of your transplant.

In the meantime, you may need to adjust your diet to reduce intake of these minerals.

A Note about the Importance of Avoiding Grapefruit:

One of the chemicals in grapefruit, tangelos, and Seville oranges (used to make marmalade) interferes with the enzymes, which break down certain drugs in your digestive system. Eating or drinking these fruits or juices may cause an increase in the absorption of Prograf and several common heart medications. These effects can last many hours, so it is not safe to simply delay your medication after consuming the “forbidden fruit.”. Contact your pharmacist if you are uncertain about your medications or if you are experiencing side effects.

Will I gain weight?

You may find that you have a better appetite after your transplant and are gaining a few unwanted pounds. Here are some ways you can control calories:

  • Eat more raw vegetables and fruits
  • Eat more lean meat, skinless poultry, and fish
  • Use nonfat dairy products
  • Drink sugar-free beverages
  • Avoid fatty, fried, and sweet foods
  • Maintain good blood sugar levels

Controlling your weight will help to keep you from developing problems, such as heart disease, diabetes, and high blood pressure. If you are having trouble maintaining a healthy weight, ask your doctor to refer you to a registered dietitian to help plan low-calorie meals and snacks and to encourage your progress.

It is important that you establish an exercise and activity plan. In addition to controlling weight, regular physical activity helps to:

  • Strengthen your heart muscle
  • Give you better form and appearance
  • Improve your endurance
  • Keep your bones healthy

Set up an exercise program with your doctor’s advice and get started as soon as you are permitted.

SNACK IDEAS TO HELP WITH NAUSEA

Nausea is a common side effect of medications. It can also get worse if you are anxious or upset. If you have persistent nausea, your doctor may prescribe anti-nausea medication. Here are some behaviors that can help:

  • Eat 6–8 small meals each day. An empty stomach can make nausea worse.
  • Eat cold foods, which have a milder taste and smell.
  • Avoid rich fatty foods.
  • Keep crackers, toast and clear soda on hand for a small snack.
  • Avoid foods that are heavily spiced.
  • Eat well when you feel well!

What foods should I eat?

Carbohydrates

Carbohydrates come from sugars and starches and provide fuel and energy for your body. When you take steroid medication, it is difficult for your body to use carbohydrates. This can lead to high blood sugar levels and puts you at risk for diabetes. For this reason, it is important to limit the number of “simple” carbohydrates in your diet, such as sugar, sweets, and soda.

“Complex” carbohydrates such as pasta, whole grain breads, unsweetened cereal and grains, and fresh fruits and vegetables should be included daily.

If you have diabetes, you will need to count the number of carbohydrate foods at each meal. Work with your doctor or registered dietitian to keep your blood sugar well-controlled.

Protein

Protein foods include meat, poultry, fish, dairy products (such as milk, yogurt, and cheese), eggs, beans, and peas. These foods are important to build and repair muscle tissues and help you heal after surgery. After your transplant, you will want to include more protein than normal to offset the muscle tissue that is broken down by large doses of steroids. When you stop taking steroid medication, you can return to eating moderate amounts of protein. You should include at least one serving of protein at each meal.

Fats

Fat is an essential nutrient that provides energy, insulation, and contour to the body. It surrounds and protects your internal organs and insulates your body from extreme temperatures. Too much fat can lead to unwanted weight gain and elevated blood lipids (cholesterol and triglycerides).

Fat quantity is not the only issue: Type of fat is also important. Here are some suggestions for making good choices:

  • Restrict fat intake to 20 to 30 percent of calories. Use only small amounts of oils, tub margarine, and regular mayonnaise. Avoid any that contain “hydrogenated” or “partially hydrogenated” oils.
  • Use fats that are liquid at room temperature, preferably monounsaturated, like olive oil, canola oil, avocado, and natural peanut butter.
  • Omega 3 fats from whole foods like nuts, seeds, and oily fish are essential to a healthy diet.
  • Choose lean meats and seafood. Fish/shellfish is always a good choice.
  • Choose fat-free and lowfat dairy products.
  • Limit added fat, such as salad dressings, margarine/butter to four teaspoons per day.
  • Avoid fried foods. Instead, bake, broil, grill, roast, steam, or microwave.
  • Limit egg yolks to 3-4 per week.

How much fluid do I need?

When you leave the hospital, your Doctor may ask you to drink 3-4 liters (about a gallon) of water each day. This is to prevent dehydration while your new kidney is learning to concentrate urine. Carefully track your intake and output on the form provided by your transplant coordinator. Your doctor or coordinator will advise you about your fluid intake based on your lab work. Eventually, you will be able to drink only when thirsty.

Do I need to follow a low-salt diet?

Most transplant recipients still need to restrict salt. Transplant medications, especially steroids, may cause you to retain fluid. Salt makes this problem worse, increasing fluid retention and raising blood pressure. Controlling blood pressure is very important to the health of your transplant. Your doctor may tell you to limit your salt intake.

Here are some common high sodium foods:

  • Table or seasoning salts
  • Soy sauce, teriyaki sauce
  • Cured meats, such as ham, bacon and sausage
  • Lunch meats, such as salami and bologna
  • Canned foods, such as tomatoes
  • Canned, dehydrated, or ramen soups
  • Condiments like mustard, pickles and olives
  • Commercially frozen entries

Other Important Minerals

Potassium

As long as your transplant is working well, you should be able to take in normal amounts of potassium from your food. However, some medications can increase your blood level of potassium, while others decrease it. If your blood level of potassium is too high or too low, your doctor may recommend some changes in your diet. If so, a registered dietitian will be able to guide you.

Some foods high in potassium are:

  • Oranges
  • Bananas
  • Avocados
  • Tomatoes and tomato sauce
  • Potatoes (white or sweet)
  • Milk and yogurt
  • Salt substitutes

Calcium and Phosphorus

You may need to pay close attention to the levels of calcium and phosphorus in your blood. If you have been ill for a period of time, your body may lack the balance of calcium and phosphorus needed for healthy bones.

In the months after your kidney transplant, your doctor will check for possible bone loss and talk to you about the best way to keep your bones healthy. In the meantime, every adult needs about two serving a day from the dairy group (milk, cheese and yogurt or a good calcium or phosphorus substitute).

Unless your doctor or dietitian has told you not to use these foods, try to include them in your meals. Your doctor may decide you need more calcium and phosphorus than this provides and ask you to take a supplement.

Do not start taking any supplement without your doctor’s knowledge because this could have an adverse effect on your transplant.

Handling Food Safely

Some of the medications you take to prevent rejection of your kidney will suppress your immune system. You may be more susceptible to colds and infections, so it is very important to decrease your risk of food-borne illness. Please follow these guidelines carefully:

Avoid High Risk Foods

  • Raw and undercooked seafood and meats, such as sushi or oyster sliders
  • Cold deli meats and poultry
  • Foods containing raw eggs, such as home-made eggnog or cookie dough
  • Smoked seafood and ready-to-eat, peeled prawns
  • Ready-to-eat deli salads
  • Pate, liverwurst, tuna salad, and meat spreads
  • Soft and semi-soft cheeses
  • Soft-serve ice cream
  • Unpasteurized eggs or dairy products such as cheese or yogurt made from raw milk

Handle Food Safely

  • Always wash hands well with soap and water. Dry thoroughly before eating and before and after handling foods.
  • Wash all kitchen utensils and food preparation surfaces with hot water and soap. Sanitize your sink and all surface areas with ½ tsp bleach in two cups of water.
  • Use separate cutting boards for fruits and vegetables versus meat, poultry, eggs and seafood.
  • Wash fruits and vegetables, even those with removable skin, under running water. Remove outside leaves of leafy vegetables and rinse leaves individually.
  • Use a thermometer to check the temperature of meats. Beef and pork should be 160 degrees, turkey and chicken 180.
  • Do not eat foods from damaged or faulty containers.
  • Do not share utensils or food from which others have eaten.

Store Food Safely

  • Separate raw and cooked foods while purchasing, storing, and preparing foods.
  • Store raw meats below other foods in the refrigerator.
  • Refrigerate or freeze perishable foods as soon as possible.
  • Cover all stored foods.
  • Do not wait for cooked foods to cool – refrigerate or freeze as soon as they stop steaming.
  • Defrost foods in the refrigerator or microwave. Never leave foods to sit at room temperature.
  • Do not freeze uncooked foods that have already been defrosted.
  • Leftover foods should be consumed within 48 hours unless frozen.
  • Store eggs in the refrigerator.

Cooking and Reheating Foods

  • Eat cold foods cold and hot foods hot. Keep cold food below 40 degrees. Keep a thermometer in your refrigerator and check the temperature once each week.
  • Reheat food until steaming hot throughout. All reheated food should reach at least 160 degrees and be served at or above 140.

Eat Out Safely

  • Ask for food to be freshly prepared.
  • Do not purchase or consume foods when either the food or its ingredients have been sitting for an unknown period of time.

When in doubt, throw it out!

You may be surprised to be on a special diet after your transplant.

Sometimes a transplanted kidney may be slow in getting started, so your doctor will have you follow some renal dietary restrictions for a while. Usually, this is only needed for a short time.

You may also be asked to drink a lot of water. Your doctor and dietitian will help to guide you through these changes.

PROTEIN FOODS

Foods Serving Size Protein Content Foods Recommended
* Meat, Fish, Poultry, Cheese & Eggs 1 ounce(or as indicated) 7 grams Beef, lamb, veal, pork, chicken, turkey, other fowl, lunch meats, fish, shellfish, cheese; cottage cheese (1/4 cup); peanut butter (2 tbsp); egg (1); tuna fish (1/4 cup)
* Milk & Dairy Products ½ cup(or as indicated) 4 grams Low fat, skim, or chocolate milk, ice cream, ice milk, frozen yogurt, pudding, custard and yogurt; half and half or coffee creamer (1 cup)
Vegetables ½ cup (raw)1 cup (cooked)(or as indicated) 2 grams Green or wax beans, cabbage, rutabagas, spinach, turnip greens, carrots, squash (summer, yellow, winter), broccoli, Brussels sprouts, cauliflower, tomato juice, eggplant, cucumber, lettuce, mushrooms, green peppers, beets; celery (2 small stalks), tomatoes (1 small), onions (1)
Breads, Cereals, & Desserts As indicated 3 grams Bread, rolls, muffins, biscuits, pancakes, waffles, sweet rolls, donuts, tortillas (1); dry cereals, jello (3/4 cup); hot cereals, pastas (1/2 cup cooked); rice (1/3 cup cooked); saltine-type crackers (6); cornbread (2” square); popcorn (3 cups); cookies (3 medium); cake (2” square); fruit pie (1 slice); sherbet(1 1/2 cup)
Fruits & Juices ½ cup 0.5 grams or less All fruits are good choices.
Fats Limited 0 grams Regular or sour cream (2 tbsp); cream cheese (1 tbsp); butter, margarine, mayonnaise (1 tsp); salad dressing (1 tbsp)

* For a heart healthy diet, choose lean cuts of meat and low-fat dairy products.