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:
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:
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:
What foods should I eat?
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 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.
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:
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:
Other Important Minerals
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:
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
Handle Food Safely
Store Food Safely
Cooking and Reheating Foods
Eat Out Safely
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.
|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.