Nutrition Guidelines for Discharge Home

Food Safety
Calories and Body Weight
Magnesium and Potassium
Fluid
Vitamin & Mineral Supplements
Protein Calcium
Nutrition Guidelines During Prednisone Treatment
Children Under 18 Years of Age

When you return home after your transplant, your immune system is still functioning below normal. You may also have increased nutrient needs due to medications or loss of muscle mass. Calories, protein, fluid, vitamins, and minerals are necessary for you to regain your immunity, maintain or achieve your weight goal, strengthen your muscles, and feel better!

Food Safety

Allogeneic patients should continue the "Immunosuppressed Diet" until off all immunosuppressive therapy (such as prednisone, tacrolimus, cyclosporine).
Autologous patients should continue the "Immunosuppressed Diet" during the first three months after transplant or until off prednisone for one month.
When you discontinue the Immunosuppressed Diet continue to use care when purchasing foods, preparing meals and dining out. Situations where you cannot control the cleanliness of the food put you at greater risk for acquiring a food-borne illness. Examples include salad bars, smorgasbords, delicatessens, bulk food bins, free food samples offered in stores. Review the Food Safety Guidelines on this website.
Continue to avoid herbal and other preparations, since they may contain harmful ingredients or infectious organisms. Herbs are not regulated for purity or for effect on health.
If you rely on well water at home, it should be tested for coliforms and Cryptosporidium immediately prior to your return home after treatment. Future testing must be performed at least once every year and preferably more frequently. To ensure safety, boil the water for one minute prior to drinking or using in recipes. Boiled water may be stored up to three days in the refrigerator. After three days it must be thrown away. (Review the "Water Safety" guidelines on this website.)

Calories and Body Weight

Your goal is to maintain or achieve an appropriate weight for your body size.
It is important to consume a nutritious diet including a variety of foods to promote recovery of your immune system.
If you are underweight, weight gain may be slow after transplant. Set small goals (2-4 pounds or 1-2 kg per month). Eat 3 meals daily, plus snacks. Drink beverages with calories and protein. Use medical nutrition supplements, such as Instant Breakfast®, Ensure®, Boost®, Scandi-Shake®, Polycose®. Exercise to promote muscle gain.
If you are overweight and medically stable (as determined by your physician and dietitian), you may lose weight gradually - 1 pound per week (1/2 to 1 pound per week for children). You must continue to consume a nutritious diet, following any special nutrition needs your dietitian has advised. Exercise is important to prevent muscle loss.
Calorie needs increase with fever, infection, and physical activity. Some people with Graft-versus-Host Disease (GVHD) may require more calories to maintain or gain weight.

Magnesium and Potassium

Chemotherapy, surgery or illness may increase magnesium and potassium losses from your body. Cyclosporine and tacrolimus increase magnesium loss from your body. Supplementation (pill or intravenous infusion) is usually necessary. Your physician may need to adjust your magnesium or potassium dose based on your serum magnesium or potassium level.
Magnesium-rich foods include nuts, bran cereals, brown rice and whole grain breads.
Potassium-rich foods include fruits, vegetables and dairy products. (Your dietitian can give you a more complete list.)

Fluid

A high fluid intake helps flush your kidneys when you take medications that can impair kidney function, including Cyclosporine, tacrolimus, and some antibiotics. Ask your dietitian for your fluid goal.
Serum (blood) Creatinine is a measure of kidney function. An above normal serum creatinine means that your kidneys are working below normal.

Vitamin & Mineral Supplements

Take a multiple vitamin/mineral supplement for one year following your transplant to ensure you get the vitamins and minerals you need while your body and immune system are recovering. A generic brand is fine. If you are considering taking any supplement (including antioxidants and herbal preparations) in addition to the vitamin/mineral supplement that has been recommended, discuss its' safety with your dietitian.

When selecting a supplement, it should:

Contain NO iron.
Not be greater than 200% of the Recommended Dietary Allowance (RDA).
Contain NO herbs or other plant materials.

Recommended Supplements For Adults

Mature Balance®
One-a-Day 50 Plus®
Centrum Silver®

Recommended Supplements For Children (Follow the dose listed on the label for the age of your child.)

Fruity Chews®
Sesame Street Vitamin Chewable Tablets®

Protein
Your protein needs were higher than normal early after transplant to allow repair of cell damage caused by chemotherapy and radiation. Protein continues to be an important part of your diet to promote recovery of your immune system. Your protein requirement returns to normal two to three months after transplant, unless you have lost a large amount of muscle or are taking prednisone.

Below are some protein-rich foods. Your dietitian will tell you your daily requirement. For calorie and protein information, please ask your outpatient nutritionist for the booklet, "A Guide to Good Nutrition.")

Protein Content of Selected Foods

Food Item	Serving Size	Grams Protien
Beans: baked lima refried	½ cup ½ cup ½ cup	7 6 8
Cheese	1 oz. or 1" cube	7
Cheese pizza (12")	¼	15
Chicken: breast thigh or drumstick wing	½ 1 1	27 14 8
Cocoa, instant - mixed with water	1 cup	3
Cooked beef, fish, lamb, pork: size of a deck of cards	3 oz.	21
Cottage cheese	¼ cup	7
Cream soup (made with milk)	1 cup	6
Custard	½ cup	7
Egg	1	6
Hotdog (10 per pound) or luncheon meat	1 or 1 oz.	5
Ice cream or ice milk	1 cup	5
Lentils	½ cup	9
Macaroni and cheese: homemade or frozen packaged or canned	1 cup 1 cup	12 7
Milk (nonfat, 2%, whole, buttermilk)	1 cup	8
Homemade Milkshake	10 oz.	9
Peanuts and other nuts	¼ cup	9
Peanut butter	2 Tbs.	8
Pudding	½ cup	4
Tofu	½ cup	10
Tuna	¼ cup	12
Yogurt: plain, coffee, vanilla fruit	1 cup 1 cup	12 9
Ensure®	1 cup	9
Ensure Plus®	1 cup	13
Instant Breakfast (made with milk)	1 serving	15
Boost®	1 cup	15
Boost Plus®	1 cup	14

Calcium
Calcium is essential for bone health, especially in:

Adult females with hormonal changes
People taking prednisone
Children and teens

Calcium Requirements after Transplant

Age	Minimum Requirement after Transplant	Requirement during Prednisone Treatment
Children	800 mg	1200 mg
Teens	1200 mg	1600 mg
Adult Males	1000 mg	1500 mg
Adult Females	1200 mg	1500 mg

Calcium Content of Selected Foods

Food	Serving Size	Calcium mg per serving
Beans: baked or refried	½ cup	65
Calcium-fortified orange juice	1 cup	300
Cheese	1 oz. or 1" cube	200
Cheese pizza (12")	¼	250
Cocoa, instant - mixed with water	1 cup	90
Cottage cheese	½ cup	70
Cream soup (made with milk)	1 cup	180
Custard	½ cup	150
Ice cream or ice milk	1 cup	175
Macaroni and cheese: homemade or frozen packaged or canned	1 cup 1 cup	200 100
Milk (nonfat, 2%, whole, buttermilk)	1 cup	300
Milk, calcium fortified	1 cup	400
Homemade Milkshake	10 oz.	320
Pudding	½ cup	150
Tofu	½ cup	130
Yogurt: plain, coffee, vanilla Fruit	1 cup 1 cup	400 315
Ensure®	1 cup	125
Ensure Plus®	1 cup	165
Instant Breakfast® (made with milk)	1 serving	500
Boost® and Boost Plus®	1 cup	200
Citracal + D®	1	315
Tums®	1	200
Viactiv® or CalBurst®	1	500

Nutrition Guidelines During Prednisone Treatment (Click here for osteoporosis guidelines)

Protein: A protein-rich diet and exercise can help prevent muscle loss. Include a protein-rich food in every meal and consume 2 to 3 protein-rich beverages or snacks daily. Exercise can include walking, bicycling, low-impact aerobics.
Calcium: Consume a calcium-rich diet and exercise daily to minimize bone loss. If your calcium intake is low, take a supplement of calcium carbonate (such as Caltrate® or Viactiv®) or calcium citrate (such as Citracal®).
Vitamin D: This vitamin helps your body absorb and utilize calcium. Children on prednisone require 400 I.U. vitamin D daily. Adolescents and adults on prednisone require 400-800 I.U. daily. Vitamin D is obtained from your multiple vitamin, fortified milk and vitamin D-containing calcium supplements.
Sugar (Glucose): If your fasting blood glucose level is above normal, ask your dietitian for diet guidelines. Avoid concentrated sweets, especially sugar-containing beverages and juices. Examples of concentrated sweets are: cake, cookies, candy, donuts, pie, soda pop, fruit-ades, fruit juice, sweet rolls, coffee cake, ice cream, sugar, honey, syrup.
Potassium: You may need more potassium in your diet while taking Prednisone. Some sources of potassium are: salt substitute, bananas, melons, oranges, orange juice, potatoes, tomatoes, tomato juice, cream of tartar.
Salt: A high salt intake can worsen fluid retention caused by prednisone. Avoid salt, and salty foods such as canned, instant, and frozen soups and entrees, soy sauce, cured meats, and packaged sauces and seasonings. In general, processed foods contain too much salt.

Your dietitian can give you a more complete list.

Children Under 18 Years of Age

Height and weight should be measured at the doctor's office every month. Record these values on the growth chart provided by the dietitian. When your child returns to the Center for long-term evaluation, bring the growth chart with you.

Discuss With Your Doctor If:

Your weight drops more than 2 pounds (1 kg) in 7 days
You develop nausea, vomiting, diarrhea, stomach or intestinal cramps
Your mouth becomes drier, sensitive, or develops sores
You have swallowing difficulties