Nutrition
A dietitian will work with you to design and implement a care plan to promote your nutritional needs. As soon as deemed appropriate by your primary nurse, the dietitian will begin diet instruction. Your nutrition history will be obtained.
You will be asked, among other questions, to state your food preferences and to describe a typical day's food intake before you were admitted to the hospital. The dietitian will determine your ideal body weight. A comparison to your present weight will indicate whether weight gain, loss, or maintenance is appropriate.
Once that decision is made, the number of calories necessary to achieve your ideal body weight is calculated. A diet plan is devised to include the appropriate number of calories and to reflect the essential diet principles indicated for your transplant.
Your diet will incorporate personal elements such as life style, food preference, food choices, and intake pattern. The overall objective is to create a plan which is practical and suitable to your life style.
You will have the opportunity to practice selecting foods from the hospital menus which correspond to your individual pattern. The expected outcome is that you can integrate the diet into your preferred life style once you leave the hospital.
Nutritional Care Plan
The diet plan is composed of several basic food principles which pertain to your nutritional needs. Some of these are more restrictive than those of the diet you received after surgery in the intensive care unit.
During that period, it was essential that you consume sufficient calories, protein and other nutrients by eating any food you could tolerate to prevent further weight loss, promote healing, and protect against infection.
As your medical condition begins to stabilize, it is appropriate to initiate a diet plan which will be the best one for your new organ(s) and provide the nutrients needed for good health. You will be pleased to learn that the diet may be more liberal than the one you followed before surgery. The basic principles of the diet are discussed below. A brief explanation of the reasons for including each principle is included.
1. Achieve and Maintain Your Ideal Body Weight
If you are underweight, it is important to reach your ideal body weight so that you have adequate fat and protein reserves for protection during periods of infection or rejection.
Once you successfully attain your desirable body weight, it is equally critical to stay within a close range, since excessive weight places an added strain on your new organ(s).
Excess weight can increase blood cholesterol, triglycerides, and glucose. All of these factors increase the risk of arteriosclerosis, elevated blood pressure, and possible coronary artery disease.
Long-term use of prednisone can also elevate blood pressure, blood glucose, and triglyceride values. Excess body weight further complicates the problem and compounds the risk of developing arteriosclerosis.
2. Limit Sugar and Concentrated Sweets
Long-term use of prednisone is associated with increased blood glucose levels. High blood glucose levels can indirectly increase blood tryglyceride levels. It is recommended that you limit your intake of sugar and concentrated sweets, and keep the total amount of carbohydrate in your diet within a moderate range.
3. Modify the Fat Content of Your Diet
Blood cholesterol levels have been shown to be directly related to coronary artery disease in the general population.
These guidelines are recommended for fat intake:
- Moderately restrict your cholesterol intake
- Decrease the total intake of saturated fats. (Saturated fats are solid at room temperature and usually of animal origin).
- Substitute polyunsaturated fats. (Polyunsaturated fats are usually liquid at room temperature and of vegetable origin).
The dietitian will work with you to integrate these principles into your diet. This includes limiting egg yolk, high-fatdairy foods and meats, and selecting non-fat milk, lean cuts of red meat, poultry, and fish.
The primary cause of coronary artery disease in the general population is chronic progressive deposits of fatty substances and fibrous tissue in the walls of the arteries. These deposited materials form atherosclerotic plaque. Cholesterol is an important constituent of these plaques.
Whether cholesterol deposition plays nearly as important a role in transplant coronary artery disease is an unanswered question, but it seems prudent to try to control cholesterol levels.
You may also be started on a class of drugs called "statins" (Lipitor, Pravachol, Zocor, etc.). These medicines are effective in reducing total cholesterol counts and lowering the levels of LDL (bad) cholesterol. They have also shown promise in reducing the incidence of graft coronary disease.
In rare cases, a drug interaction between cyclosporine and tacrolimus with the "statins" can cause serious muscle pain and damage. If you experience a sudden onset of unexplained muscle pain, stop the cholesterol medicine (the "statin") and call your transplant center. An easy blood test can verify if it is safe to resume the drug or not. Do not stop the cyclosporine or tacrolimus; only the "statin."
Evidence also shows that blood cholesterol levels are influenced by the amount of dietary cholesterol, saturated fats, and total fats. Blood cholesterol levels can be lowered if both the total amount of cholesterol and saturated fat are decreased and poly-unsaturated fats are substituted.
We advise you to follow the dietary fat modification even if your blood cholesterol level is within normal range and you have no prior history of coronary artery disease. There is no level which is considered too low, since the risk of developing arteriosclerosis continues even with cholesterol levels in the normal range.
4. Restrict Your Sodium Intake
To avoid fluid retention and aid in control of high blood pressure, we recommend that you follow a no-added salt diet.This means that food may be lightly salted during cooking, but no salt is added at the table. Avoid highly salted foods.
The dietitian will instruct you on which foods should be specifically avoided. You will have the opportunity to identify which items are of particular concern because they are often favorite foods, frequently eaten.
Although many patients take diuretics to control fluid balance, these drugs are less effective if you concurrently tax your body with excessive sodium. You will be responsible for monitoring your sodium intake and carefully observing your body's response to diuretic treatment.
You will select your meals from the quantitative menu or no-added salt menu which offers food choices corresponding to the principles of your diet. The dietitian will suggest appropriate snacks and nourishments, and answer any questions you may have about choosing items on the menu for meals.
Provided there are no indications to the contrary, your diet plan may include a moderate amount of alcohol each day. A moderate amount is defined as: 4 ounces of dry table wine, 8 ounces of beer, or 11/2 ounces of gin, whiskey, vodka or rum.It is important to emphasize that the principles presented above are intended to serve as guidelines rather than a specific dietary prescription.
The overall goal is to assist you in selecting foods which promote sound nutritional health without aggravating the metabolic consequences of immunosuppressive therapy. Presently, there is no means of guaranteeing protection against degenerative conditions that can develop. However, by following these guidelines you are assured that your diet is not contributing to the development of complications which may arise.