Download 2016-conference-nutrition-talk

Nutrition in the Transplant Journey
TRIO MARYLAND
Christine Hare RD CSR LDN
Dennis Myers RD CSR LDN
10.8.16
Today’s Objectives
 Learn about the importance of nutrition throughout the
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transplant process
Pre-transplant, immediately post-operative, long-term posttransplant nutrition guidelines
Discuss nutrients that need to be focused on or limited
Discuss medication interactions / side-effects
Popular diets- can they be used by transplant patients?
Time for questions!
Pre-transplant
 Optimize nutrition status
 Low sodium diet
 Most organ transplant recipients should be limiting sodium
 Maintain appropriate protein intake
 Lower protein intake for those not on dialysis; higher with
dialysis
 With liver disease often more protein is needed
 Adjust electrolytes as needed
 With kidney disease, often limit potassium, phosphorus
 Maintain / strive for healthy weight
Nutrition and transplant- why is it
important?
 Post-operative healing
 Having a transplant is a big operation!
 Proper nutrition helps with healing
 Adequate protein intake
 Blood sugar management
 Electrolyte management
 Long-term health
 Weight management
 Disease specific management
 Stabilization of electrolytes
Post-operative nutrition
 Focus on lean protein
 Protein is very important to help heal our bodies
 Surgical wound closure
 Body in catabolic state, breaks down muscle
 Manage blood sugars
 If diabetic, important to be on proper medications
 Prednisone likely will affect levels
 Consistent carbohydrate intake
 Balance electrolyte imbalances
 Often magnesium and phosphorus are low; potassium variable
 Low sodium diet generally is maintained
 Drink water!
 Big change for anyone that was on hemodialysis
Healthy Nutrition Post-Transplant
 Maintain / strive for healthy body weight
 Manage any health issues (i.e. high blood pressure, DM, high
cholesterol)
 Keep electrolytes within target range
 “Heart healthy” diet = “Transplant healthy” diet too!
 Food safety
 Cook meats to proper temperature, avoid raw / undercooked
meat/seafood; wash fruits / vegetables
 Keep hot food hot; cold food cold
 Drug-nutrient interactions
 Grapefruit / grapefruit juice; also pomegranate juice
 Use caution with Fresca™, Sunny Delight ™ as they have small
amounts of grapefruit juice
Healthy Body Weight
 Can be a challenge for everyone, but particularly after a
transplant!
 Feeling better= increased appetite
 Steroids (Prednisone) = increased appetite
 Less dietary restrictions = more acceptable choices
Decreased use of Prednisone
 One big change in transplant over the past 10 years is less
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steroid usage, and at lower doses
Prednisone affects carbohydrate metabolism in our bodies
and fat storage
Weight gain in abdomen and in face “moon face”
Prednisone also is hard on our bones
If on Prednisone, try to limit simple sugars and focus on lean
protein and vegetables
Working on weight goals
 Focus on fiber- fiber helps keep us full; aim for 25-35 grams fiber a day
 Whole grains, legumes, vegetables, fruits
 Try to choose whole fruits vs. fruit juice, fresh / frozen veggies
 Choose lean proteins
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At least 93% lean ground beef / turkey
Look for words “loin” and “round” leaner cuts
Take skin off of turkey/chicken choose light meat
Include fish
Beans/legumes/nuts
Low fat dairy
Eggs / Egg-whites
 Limit fried foods
 When frying use minimal oil and mainly monounsaturated fats such as olive oil, canola oil,
sesame oil
 Watch portion sizes- this is key!
 Focus on REAL FOOD, less processed foods
Estimating Portion Sizes
Breads, cereals, rice, and pasta
• 1 bagel = 1 hockey puck
•1 medium potato = a computer mouse
•½ cup rice = 1 cupcake wrapper
•1 cup dried cereal= a fist
Fruit
• 1 medium fruit = 1 baseball
• 1 cup fruit = 1 tennis ball
• 1/3 cup of dried fruit = 1 large egg or a golf ball
Meat
• 3 ounces of lean meat, chicken or fish = 1 deck of playing cards or a bar of soap
• 1 ounce of meat = a match box or a floppy disk
• 3 ounces of fish = 1 checkbook
Dairy
• 1 ½ ounces natural cheese = 3 dominos, or a 9-volt battery
• 1 ounce of cheese = 4 dice, 1 small child’s block, or 2 saltine crackers
Fats, oils and sweets
•½ cup of ice cream = ½ tennis ball
• 2 Tbsp. of margarine, salad dressing, peanut butter, or mayo = 1 ping pong ball
• 1 tsp. of margarine, salad dressing, peanut butter, or mayo = 1 die (dice)
• 1 ounce of hard candy or nuts = 1 layer covering the palm of your hand (flat layer)
•http://blog.myfitnesspal.com/beginners-guide-portion-sizes/
Healthy Weight
 Try to balance your plate and make ½ of your plate vegetables
 Drink mainly non-caloric fluids such as water
 Limit fried foods / added fats
 Exercise regularly
 Try using a pedometer to track your steps- aim for 10,000 a day
 MyFitness Pal and Lose It are great apps that track intake and exercise
 Keep a food diary to help track your intake
 Most of us underestimate what we eat by 1/3
 Be mindful of beverages as well
Potassium and portion control…
 Potassium is a mineral that is usually very healthy, but for
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some of us due to kidney dysfunction or medication we have
to be careful with it. Even “low potassium” choices such as
strawberries can become “high potassium” if the portion is
large
5 berries: 92 mg LOW POTASSIUM
8 berries: 147 mg MEDIUM POTASSIUM
15 berries: 275 mg HIGH POTASSIUM
25 berries: 450 mg VERY HIGH POTASSIUM
Limit sodium intake
 Aim for less than 2,000 mg of sodium
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per day
One teaspoon of table salt has 2,300
mg of sodium
Read food labels
Choose more fresh / frozen, less
canned
If canned, opt for lower sodium
choices; rinse off.
 Keep in mind “Low Sodium” on label
means 30% less, not necessarily low in
sodium
 Eating out usually has much more
sodium
 Prepare and look at menu in advance if
possible
° Watch the “extras”- things like
cheese, sauces, and dressing can add
a lot of extra sodium
° Look at the serving size
Phosphorus and Magnesium
 Phosphorus may be low post-
transplant
 Good dietary sources include
dairy products, whole grains,
beans, nuts / nut butters,
dark sodas, and protein foods
 Supplement may be needed
 Magnesium also may be low
post-transplant
 Good sources include dairy
products, whole grains, nuts
/ seeds, dark leafy greens
 Supplements often required
 Mag-ox, Slo-Mag
 Magnesium supplements may
cause diarrhea; monitor
Medication Side Effects- Prednisone
 Use / Side Effects
 Maintenance / rejection
 Increased appetite
 Retain fluids
 Weight gain
 “moon-face”, abdominal weight
 Increased blood sugars
 Can lead to bone breakdown
 Managing Side Effects
 Keep food diary to track
 Try eating 6 small meals
 Drink mainly non-caloric fluids
(water especially)
 Limit sodium intake
 Limit simple carbohydrates
 Focus on lean proteins,
vegetables, complex carbs
 Weight bearing exercise
 Adequate calcium / Vitamin D
Medication Side Effects
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Cellcept / Myfortic
Gastrointestinal issues
Nausea / Vomiting
Diarrhea
Talk to your doctor /
transplant coordinator about
any side effects you are having
Small, frequent meals of
easier to tolerate foods may
help
Prograf
 May have elevated potassium
 Low magnesium
 Hair loss
 Biotin may help
Cyclosporine
 Elevated Cholesterol
Rapamune
 Elevated lipids / TG
 Impaired wound healing
New Onset Diabetes After Transplant
 Medications
 More prevalent in overweight
/ obese / older patients
 In kidney transplant patients,
there is improved kidney
function, insulin moves more
quickly through body
 Goal of maintaining healthy
weight
 Losing 5-10% of body weight
may be effective in decreasing
insulin resistance
 Consistent carbohydrate diet
 Whole grains
 Choose carbs with fiber
 Fruit, vegetables
 Follow up with diabetes
doctor
Elevated Cholesterol
 More common with certain
medications
 Diet may be less restrictive
than pre-transplant
 Post-kidney transplant foods
like cheese, chocolate may be
introduced
 Focus on lean protein choices
 Make ½ plate vegetables and
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fruit
Choose whole grains
Limit sweetened beverages
Limit fried foods
Choose monounsaturated /
polyunsaturated fats
Exercise
Review
 Overall post-transplant the
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focus is on a “heart healthy
diet”
Strive for a healthy weight
Stay active
Focus on Food Safety
Avoid foods that interact with
medications
Drink plenty of water
Communicate with your
healthcare team
Popular Diets- What Works with
Transplant?
 Gluten Free
 Medifast
 Shakeology
 Paleo
Gluten Free
 Best for Celiac disease and people with wheat/gluten
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allergies / intolerances
Celebrity Endorsements
Better athletic performance?
Feeling of well being?
Remember gluten free does not mean calorie, carbohydrate,
or sodium free
Medifast Diet
 Shakes / bars for meal substitutes
 One meal: “Lean and Green”
 Focus on lean protein, fiber
 May be appropriate if kidney function adequate
 Important to learn how to make good choices for long-term
weight management
 Can get tiresome of same shakes / bars
Shakeology Type Diets
 Substitute protein shake for meal
 Read all ingredients
 Be careful with additives (herbs, grapefruit juice, etc.)
 Count total protein and carbohydrate in portion consumed
 Important to learn about healthy eating overall; difficult to
stay on shakes forever
Paleo Diet
 Hunter –Gatherer diet
 Like Atkins diet-low carbohydrate
 Advocates meat and plants.
 Restricts entire food group
 Heart disease
 Cost
Recommended diets
 Mediterranean Diet
 Dash diet
 Weight Watchers
Mediterranean Diet
 Predominant foods of
countries surrounding the
Mediterranean Sea
 Includes plenty of fish,
vegetables, fruits and olive
oil
 Meat and sugars
occasionally
Dash Diet
 High Potassium-Low Sodium
 “Dietary Approach to Stop Hypertension”
 Monitor potassium levels
 Lots of fruits and vegetables
 WWW.NHLBI.NIH.GOV (for more information and sample
meal plan)
Weight Watchers
 Points Plus Program(more than 40,000 foods on their
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website)
Balanced approach
Learn how to make healthy choices long-term
Community support (online, or meetings)
Can do online (3months-$65.00)