Food Guidelines After Transplant

As a transplant recipient, you can expect to be thoroughly briefed by your transplant team about the risks of graft rejection.

Graft rejection refers to your body’s rejection of the new organ, much like the way your immune system would fight an infection from a virus or bacteria. Because this reaction is natural and occurs without forewarning, it is absolutely necessary for transplant patients to take a special form of medication referred to as immunosuppressant medicines. This medication assists you in suppressing the immune system from attacking the new organ, increases the chances of your body accepting the new organ and ensures longevity of the organ. 

However, the disadvantage of such medication is that it causes you to become more susceptible to infections from viruses and bacteria that may be found in the food you consume. If you happen to fall victim to a food borne disease, as a transplant patient, you are more likely to have greater difficulty in recovering in comparison to the way you were prior to taking these medications and compared to those who are not immunosuppressed. The chances of hospitalisation and immediate medical intervention are also likely to be higher, depending on the severity of your condition. In order to avoid falling prey to such food borne diseases, it is essential for you to exercise caution in all aspects of food handling and ensure that you are buying, storing, cooking and eating your meals in a hygienic way.

As a patient who has undergone liver transplant surgery, the speed of your recovery is highly dependent on the support and care your body receives from you. There are a number of things you can do to help your body recover faster. 

Apart from regular exercise and the timely consumption of immunosuppressant medication, it is extremely important to eat right. Your physician or doctor will have prescribed for you, a customized diet to follow post-surgery. The list is usually prepared taking into consideration your eating habits, nutritional requirements and other factors, while also keeping in mind which foods or food groups may cause an adverse reaction or trigger an undesirable effect. It is important that you always follow a strict hygiene protocol when it comes to consuming food- whether at home or when you dine out.

Good Food and Hygiene

While it is important for everyone to undertake safety measures when consuming any type of edibles, it is absolutely crucial that you, as a transplant patient, exercise a greater level of caution and diligently follow guidelines for food safety. A compromised immune system will make you more susceptible to food borne diseases, therefore food safety cannot be compromised at this point.  Food safety refers to a number of things ranging from how the food is prepared, which ingredients have been used in the preparation of making it, how fresh the food is, how well it is packaged and stored and the utensils used in serving it.

Be sure to only consume freshly cooked food as much as possible. If you must store leftover food, pack it in an airtight container and refrigerate it immediately. Avoid eating food cooked and stored over a couple of days. Even if you choose to eat food cooked previously, do not consume anything that has been stored in the fridge for longer than 48 hours. When you eat fruits or vegetables, make sure they are washed and dried very well. Use clean cutlery and chopping boards.

Once you realize the role of the immune system in your body, you are in a position to appreciate why food hygiene is given priority. The immune system helps the body fight infections. Infections can be caused by bacteria or viruses. When the immune system is weakened by supplements, your body is more prone to infections from contaminants in the food you consume. Some infections can cause severe and debilitating side effects that can quickly escalate to something more dangerous. Some symptoms of infections to look out for are headaches, nausea, fever or sore throat.

When eating home cooked foods, make sure to wash the vegetables well, so that any contaminants on the surface are removed by fresh running water. 

This will take care of any: 

• bacteria and viruses that occur naturally
• residue of pesticides or insecticides 
• other harmful chemicals  
• contaminants that may have managed to get onto the surface at the storage facility or while being transported. 

Buy produce and other essentials, including meat and poultry from stores that insist on high standards of cleanliness and hygiene.

A common way in which food borne illnesses spread is due to “cross contamination”. This occurs when blood or other juices from uncooked meat happen to come into contact with other food. For example, if all foods are being prepared on the same chopping board without washing the board in between, the chances of cross-contamination become greater. 

This can be avoided if you ensure the use of separate utensils for meat and vegetable preparation. It also helps to keep your countertops clean and wash your cutting boards and knives frequently. If you cut meat on a chopping board and spread it on a plate to cook it in the oven, remember to wash every surface it comes in contact with, in soapy water.

There are a few thumb rules you can follow easily when you buy groceries from a store. Remember to never buy packaged food products that may be damaged or puffed or leaky. If the package is bulging or cracked, it is likely to have spoiled or become inedible. Do not consume contents from such packages if they have any dents or visible damage to the outer layers. As much as possible, cook fresh food in a clean environment at home and avoid buying pre-cooked seafood. Most of the packaged goods in supermarkets are produced in mass and have preservatives to increase their shelf lives.

Avoid purchasing foods or produce from roadside vendors or other places that may not take high measures of hygiene. As they are perishable in nature, make sure the produce you pick out are fresh and firm to touch. When buying meat, poultry or other packaged meals, always read the use by date or expiry date. Look for fresher options where possible. Do not buy products beyond their use by date. Some people use products for a couple of days after their expiry date also, assuming they cannot have gone terribly bad so soon. Discard such packages even if you cannot see any visible difference.

It is extremely important to maintain a high standard of cleanliness at home. Be sure to scrub all utensils, pots, pans, cutlery and chopping boards well in soapy water and wash them thoroughly after every use. Using a chopping board without any grooves is highly recommended as small miniscule pieces of meat or poultry may be hard to remove when they are embedded in such grooves. If you are able to use a dish washing machine, it is recommended that you use the machine rather than wash by hand. Even if the kitchen towels, sponges and scrubs do not look dirty to the naked eye, wash them regularly in soapy water and let them dry completely before using them again.

When cooking meat and poultry, it is important to cook them to meet the standard of “well done” as undercooked meats can pose a threat. It may be a good idea to invest in a food thermometer to check the temperature at which the food is getting cooked. Here is a rough thumb rule to go by when cooking meats. 

The figure shows the minimum internal temperature of the dish being cooked.

The Five Categories of Food

Diary Products are an excellent source of calcium that help keep your bones strong and healthy. Some examples are milk, yogurt, cheese, etc.

Fruits and Vegetables are a great source of minerals, vitamins and dietary fibre, fruits and vegetables should ideally take up the biggest portion of a meal.

Grains and Cereals are high fibre and avoid ones that are processed or refined as their nutritional value is lower. Pick wholegrain rice, bread, pasta and cereal when possible.

Meat, poultry, tofu and legumes are very rich in proteins and are essential for our bodies to make haemoglobin and adrenalin. Proteins help build and repair tissues, muscles and organs.

Fatty products such as butter and oils should be consumed sparingly as they are packed with cholesterol and can adversely affect the body if consumed in large quantities.

While an understanding of the different classifications of the food helps us prioritize what we would like to consume in order to meet our health goals, it is also important to internalize where each of these categories falls in the food pyramid. The food pyramid you see below is a generic one and based on your specific food habits (vegetarian/ vegan), a dietician or your physician will be able to customize it to your level of comfort. They will be able to include your preferences and make necessary modifications.

How to read nutrition labels and ingredient lists

Most of us have seen nutrition labels on food packages but we don’t often take the time to read them. Even when we skim over the label, we don’t always understand how to decipher what the label is telling us about the benefits of the food or what the optimal range of values is for our bodies. There are a few things you can look for in nutrition labels and ingredient lists that will help you make better food choices when you are shopping.

Before we get to that, it is important to understand what a well-balanced diet looks like. Once you have a general idea about the food groups and their functions, you are more likely to make better informed choices about your meals. As discussed above, foods are basically classified into 5 distinct groups, based on their specific functions, nutritional properties, biological classifications and what they bring to your body. Primarily, the groups cater to our nutritional requirements of carbohydrates, proteins, vitamins, minerals and fibre. While helping yourself to multiple servings of fresh fruit and vegetables is most desirable, there are other categories of food that you must consume only sparingly in order to maintain a good Body Mass Index. These foods include items that are high in fat and have a tendency to increase bad cholesterol levels in your body, such as oils, cheese, clarified butter, etc.

Now, let’s look at how to go about interpreting the data on a nutrition label. To begin with, check how many servings the package contains. Understand that the recommended serving size is very generic and based on how much people usually consume that product in one sitting. The units are standardized to make the reading easier in terms of cups, tablespoons or number of pieces like in cookies or gummies. It is not a recommendation to you specifically. So, if you eat 2 servings of the product in the below image, you should ideally be calculating twice the calories, and daily percentage values in order to accurately understand how much nutritional value you are deriving out of it. Typically, the percentage values provided on most such labels cater to a person whose average calories consumption is 2000 per day.

Next, let’s look at the calories per serving. This refers to how much energy you would gain from consuming one serving of the product. Similar to percentage values, if you consume more servings, you must accordingly calculate extra calories gained from them. While the calories are calculated from the amount of product consumed in each serving, you may or may not require that much. Your body’s calorie requirement may be more or less than 2000 per day, depending on a host of factors including your age, sex, height, weight, exercise patterns, etc. In order to maintain a healthy body weight, you must consume calories proportionate to how much your body ends up using them.

The third component of the label tells you exactly what nutrients you are likely to get from the food or drink. If you have a clear understanding of your need in terms of diet or a weight reduction or weight gain plan, you may choose a food or drink that supports your goal. If there are desirable nutrients that you find higher in one product and lower in another, choose the former. Similarly, if there are some nutrients that you are trying to avoid or limit, check the labels of foods you buy to make sure that the said nutrient is either completely absent or is in a very low quantity.

For example, a high intake of saturated fat and sodium is associated directly with increasing the risk of cardiovascular problems and high blood pressure. Added sugars make up for a lot of undesired calories, taking up a lot of your daily allowance. They are best avoided as they tend to sneak up into your diet in most store bought products. Natural sugars refer to the sugar that occurs naturally in plant based items like fruit and dairy products like milk. If a product label shows “included added sugars” it just means that the total sugars indicated in a sum total of naturally occurring sugars and any artificial sugars added, such as sucrose or dextrose.

It must be remembered that there are some nutrients that are usually found to occur rarely in foods and drink but are very important to a balanced diet in human beings, such as Vitamin D, Iron, Calcium, Potassium and dietary fibre. That is why, we often find milk, almond milk and other dairy products that are fortified with Vitamin D.

You must also take a minute to check the date printed on the packaging that tells you a timeline by which the product must be ideally consumed. An “expiry date” clearly tells you not to consume the food or beverage beyond that date. Some other ways of indicating the best time to consume a product are printing a “Use by date” or a “Best by date”. They are indicative of the best time to consume the product beyond which the taste and quality is likely to deteriorate but may not become inedible right away. However, if you ever feel suspicious about a food or drink, or if it has been left outside when it should have been in the fridge, do not risk consuming it. When in doubt, always choose the safer choice.