TransplantNutrition

Transplant Nutrition: 

Transplant Nutrition Michelle Stessman, RD, LD University of Minnesota Medical Center, Fairview

Long Term Goals after Transplant: 

Long Term Goals after Transplant Obtain a healthy body weight Maintain serum cholesterol levels < 200 mg/dL Maintain blood glucose levels between 70 and 125 mg/dl Maintain bone density at levels normal for age Maintain blood pressure < 130/85

Usual Medications: 

Usual Medications Steroids (Prednisone) Cyclosporine (Sandimmune, Neoral, Gengraf) Tacrolimus (Prograf) Azathioprine (Imuran) Mycophenolate (CellCept) These medications can change the way your body works – causing fluid retention, increased appetite, elevated cholesterol and bone loss. Because of this, your diet will play a big part in your health.

How is this Accomplished?: 

How is this Accomplished? Healthy Eating Exercise Avoidance of Smoking Calories in = Calories out Choosing wisely from the food pyramid Adequate fiber – at least 25 grams per day Adequate fluid intake

MyPyramid.govSteps to a Healthier You: 

MyPyramid.govSteps to a Healthier You

Make certain you get enough of these food groups: 

Make certain you get enough of these food groups Fruits Vegetables Whole grains Dairy products http://www.health.gov/dietaryguidelines/dga2005/recommendations.htm

Slide 7: 

Consume a sufficient amount of fruitsand vegetables while staying within energy needs. Choose a variety of fruits and vegetables each day. Recommendations 1 & 2: fruits and vegetables

Focus on fruits: 

Focus on fruits Eat 2 cups of fruits per day (for a 2,000 calorie diet). Select fresh, frozen, canned, or dried fruit, rather than drinking fruit juice, for most of your fruit choices. Limit juices to 4-6 ounces per day Limit dried fruit to ¼ cup per day

Vary your veggies: 

Vary your veggies Eat 2½ cups of raw or cooked vegetables per day (for a 2,000 calorie diet). Choose vegetables without added sodium or fat most often 2 cups raw leafy greens = 1 cup of vegetable

Slide 10: 

“For optimum health, scientists say eat a rainbow of colors. Your plate should look like a box of Crayolas.” ~Janice M. Horowitz,TIME, January 12, 2002

Recommendation 3: Grains: 

Recommendation 3: Grains Eat six “1 ounce-equivalents” of grain products daily (for a 2,000 calorie diet): Make at least half of your grains whole grain. The rest of grains should come from enriched or whole grain products.

Definition: 1 ounce-equivalent: 

Definition: 1 ounce-equivalent In the grains food group, a “1 ounce-equivalent” is the amount of a food counted as equal to a 1 ounce slice of bread. Equivalents: 1 slice bread, ½ of an English Muffin or ½ of a bun ½ cup cooked pasta, cooked rice or cooked cereal 1 cup ready-to-eat cereal

Definition: Whole grains: 

Definition: Whole grains Foods made from the entire grain seed (usually called the kernel) which consists of: Bran Germ Endosperm If the kernel has been cracked, crushed, or flaked, it must retain nearly the same relative proportions of bran, germ, and endosperm as original grain to be called whole grain.

Gains with whole grains: 

Gains with whole grains “Refined grains have been milled — the bran and germ are removed. This process also removes much of the B vitamins, iron, and dietary fiber. …some refined grains are enriched. This means certain B vitamins (thiamin, riboflavin, niacin, folic acid) and iron are added back after processing. Fiber is not added back to most enriched grains.” http://www.pueblo.gsa.gov/cic_text/food/grain/train.pdf

Examples of whole grains: 

Examples of whole grains Whole wheat Whole oats/oatmeal Whole grain corn Popcorn Brown & wild rice Whole rye Whole grain barley Buckwheat Tritacale Bulgur (cracked wheat) Millet Quinoa Sorghum

Label reading and whole grains: 

Label reading and whole grains Choose foods with a whole grain ingredient listed first on the label’s ingredient list. Ingredients are listed in descending order of weight (from most to least).

Which is the whole grain bread?: 

Which is the whole grain bread?

Answer: has WHOLE wheat as the first ingredient!: 

Answer: has WHOLE wheat as the first ingredient! B

Color and whole grains: 

Color and whole grains Color is not an indication of a whole grain. Bread can be brown because of molasses or other added ingredients. Read the ingredient list to see if grain is a WHOLE grain. Wheat flour, water, high fructose corn syrup, molasses, wheat bran … NOT whole grain!

Watch wording on grains!: 

Watch wording on grains! Foods are usually not whole grain products if labeled with these words: Multi-grain Stone-ground 100% wheat Cracked wheat Seven-grain Bran

Recommendation 4: Dairy: 

For information about non-dairy sources of calcium, see MyPyramid.gov Recommendation 4: Dairy Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products: You may need more if you are taking any steroids (Prednisone)

Dairy products: 

Dairy products Equivalents: 8 ounces low fat milk 1 cup low fat yogurt 1½ ounces natural or 2 ounces processed cheese 8 ounces fortified orange juice 8 ounces fortified soy milk ½ cup low fat ricotta cheese Salmon or sardines with bones Photo: Courtesy of National Dairy Council®

For lactose intolerant: 

For lactose intolerant Eat small portions of dairy foods; gradually increasing amount. Combine dairy foods with other foods. Try non-milk dairy foods Cheeses Yogurt made with live, active bacteria Pre-digested lactose Lactose-hydrolyzed milk Commercial lactase preparations (capsules, chewable tablets, solutions)

Considerations: Other food groups: 

Considerations: Other food groups

Go Lean for Protein: 

Go Lean for Protein Choose lean meats, poultry and fish. Bake it, broil it, or grill it. Vary your protein choices — with more fish, beans, peas, nuts, and seeds. Eat 5½ ounces (or equivalent) of lean meat, poultry or fish (for a 2,000 calorie diet).

Slide 26: 

In the meat & beans group a “1 ounce-equivalent” is considered the following: Equivalents: 1 ounce lean meat, skinless poultry or fish ¼ cup cooked dry beans or peas 1 egg 1 tablespoon peanut butter ½ ounce of nuts or seeds Definition: 1 ounce-equivalent

Slide 27: 

Definition: Oils Oils are fats that are liquid at room temperature, such as vegetable cooking oils. Oils come from many different plants and from some fish. Most of the fats you eat should be polyunsaturated (PUFA) or monounsaturated (MUFA) fats. Oils are the major source of MUFAs and PUFAs in the diet. PUFAs contain some fatty acids that are necessary for health—called “essential fatty acids.”

Acceptable oils: 

Acceptable oils Common oils such as: Canola Corn Cottonseed Olive Safflower Soybean Sunflower Some oils used mainly as flavorings, such as walnut oil and sesame oil. A number of foods naturally high in oils, like: Nuts – Avocados Olives – Some fish Foods that are mainly oil, such as mayonnaise, certain salad dressings, and soft margarine (tub or squeeze) with no trans fats.

Unacceptable oils: 

Unacceptable oils Saturated Fats: - Lard - Bacon Grease - Butter Trans Fatty Acids Crisco Stick Margarine A number of foods are high in saturated fats, like: - Bacon - Cheese - Fried Foods - Fatty Meats * ribs * sausage * brats Foods high in trans fats - Restaurant Meals - Pastries - Frozen Meals

MyPyramid homepage: 

MyPyramid homepage Check here for more information on the food groups & related topics

Slide 31: 

Definition: Discretionary Calories Depending on the foods you choose, you may be able to spend more calories than the amount required to meet your nutrient needs. These calories are the “extras” that can be used on luxuries like solid fats, added sugars, and alcohol, or on more food from any food group. They are your “discretionary calories.”

MyPyramid “discretionary calories”: 

MyPyramid “discretionary calories”

Recommended foods vs. “discretionary calories”: 

Recommended foods are: Lowest fat form of food No added sugar Discretionary calories may include: Higher fat forms of food Foods with added sugar Increased intake of basic food groups Most solid fats and all added sugar calories are discretionary calories Recommended foods vs. “discretionary calories”

Slide 34: 

For many people, the discretionary calorie allowance is totally usedby the foods they choosein each food group, such as higher fat forms of foods or sweetened products.

Healthy Eating: 

Healthy Eating Consume a varied diet Eat at regular meal times Limit the ‘extras’ added to your foods if you are concerned about weight gain Make smart snack choices Do not drink your calories Do not do any other activities while eating

High Blood Sugars: 

High Blood Sugars Eat at regular meal times Limit amount of liquids you drink that have calories/sugar (juices, lemonade, Kool-Aid) Limit amount of sugar added at meals and snacks (jelly, sugar, honey, syrup) Choose snacks and foods without added sugars (fruit, plain yogurt, popcorn, etc) Choose high fiber and whole grain items Choose smaller portions of grains (usually recommend 2 servings per meal)

Maintain Bone Density: 

Maintain Bone Density Adequate calcium intake - 1500 mg after transplant Adequate Vitamin D intake - found in many fortified dairy products (labeled as Vitamin D3 on ingredient list or noted as a percentage on food labels) Weight bearing exercises Quit smoking

Maintain Blood Pressure: 

Maintain Blood Pressure Follow a low sodium diet (around 2400 mg/d) Do not add salt to foods Avoid condiments with added sodium Choose foods with the least amount of packaging Anything that makes your life easier probably has a lot of sodium  Be aware of restaurant meals

Sources of Sodium : 

Sources of Sodium Salt - 1 teaspoon = 2300mg Condiments - soy sauce, BBQ sauce, salad dressings, hot sauce Seasonings - seasoning salts, lemon pepper, garlic salt Canned Foods Sport Drinks - PowerAde, Gatorade Fast Food and Restaurant Meals Boxed meals - Hamburger Helper, Mac and Cheese, etc. Cheese Soups - Ramen, canned, frozen Frozen Meals Snack Foods - Chips, Crackers

Keep track of your intake for 2-3 days: 

Keep track of your intake for 2-3 days

Label Reading : 

Label Reading The information on the label is based on this serving. If you eat double the serving, the nutrients will be doubled as well Choose snacks, cereals, dairy products and desserts with 3 or fewer grams of fat per serving Choose meat and cheese with 5 or fewer grams of fat per serving Choose food with less than one fourth of the total fat coming from saturated fat Minimize intake of trans fats

Behavioral Change: 

Behavioral Change Make food less visible at home and work Avoid situations that are tempting Eat slowly – chew well and take small bites Make eating an experience Keep a food diary to limit mindless eating Reward yourself with non-food gifts Identify emotions that lead to eating * boredom, loneliness, anger