Nutritional Management After Lung Transplantation

Good nutrition plays a key role in recovering from lung transplantation. As after any surgery, adequate calories and protein are needed for proper wound healing. Also, possible side effects of the anti-rejection medications can increase nutrient requirements. Because of these special concerns, you may have to change your diet for a time period after your transplant. However, dietary therapy is always adjusted by the transplant team to meet your specific needs and tolerances.

General Dietary Recommendations

  • No grapefruits or grapefruit juice as this may interfere with medications.
  • No uncooked food such as sushi or meat. Meat should be well done.
  • Raw vegetables need to be washed and scrubbed by someone else other than you. Raw fruits and vegetables, especially root vegetables, may contain fungus. Fungus may be inhaled and cause lung infection.
  • Avoid raw fruits and vegetables for the first 3 months after transplant
  • No salads at public salad bars — to avoid infection from the salad and from the other diners.

Short Term Nutritional Management

Protein Intake

In the first month following lung transplantation you will be recovering from the stress of surgery. It is important to consume enough protein, and total calories, to help your wounds heal. You also need added protein to help overcome muscle breakdown caused by high doses of prednisone. To help meet your protein needs, the following foods are recommended:

  • Meats (beef, pork, poultry, turkey, seafood)
  • Fish
  • Dairy products (milk, cheese, yogurt) must be pasteurized
  • Eggs (but no more than 3 to 4 yolks per week)
  • Egg substitutes (egg whites)

The following are vegetarian selections high in protein. When taken in adequate amounts as part of a well-balanced diet, these foods meet your protein needs:

  • Nuts
  • Split peas
  • Soy products
  • Dried beans
  • Peanut butter
  • Tofu

Sugars

Steroid medications can decrease the body's ability to use its blood sugar for energy. This can cause increased blood sugar (glucose). This condition is called hyperglycemia or steroid-induced diabetes.

Avoiding concentrated carbohydrates will help decrease the side effects of steroid medications.

These foods are high in simple sugars and should be avoided:

  • Sugar
  • Canned fruit or juice with added sugar or syrup
  • Honey
  • Chewing gum with sugar
  • Molasses
  • Soft drinks
  • Syrup
  • Sweetened mineral water
  • Sugar pies
  • Cookies, candy
  • Doughnuts and sweet rolls
  • Sweetened condensed milk
  • Fruited yogurt
  • Ice cream
  • Jams, jellies, marmalades
  • Sherbert
  • Puddings
  • Fruit ice
  • Frozen fruit or juice with added sugar or syrup
  • Jello

If you develop hyperglycemia, your diet may need to be changed to include the following guidelines:

  • Eating three meals per day are recommended, consumed at regular and evenly-spaced times.
  • Limiting fruit to one serving per meal, and eating fresh or water-packed canned fruit only (no syrup or added sugar).
  • Reading food labels to avoid foods with sugar, honey, sucrose, dextrose, or corn syrup listed as the first or second ingredient.

Sodium (salt)

Prednisone can increase sodium and water retention and increase your blood pressure. Therefore, sodium may need to be restricted in your diet. The "no added salt" diet is generally prescribed. Salt contains sodium, so it is best to limit salt when cooking and not add salt at the table. High sodium foods to avoid include:

  • Commercial Soups: Bullion cubes, dehydrated soup mixes, canned broth and canned soup (unless labeled "low sodium")
  • Processed Meats: Ham, bacon, sausage, frankfurters, cold cuts (bologna, salami, pastrami), corned beef, smoked or dried meat or fish.
  • Canned meats and fish (unless labeled "no salt added")
  • Salt pork, processed cheese, and frozen packaged dinners.
  • Processed Vegetables: Pickles, sauerkraut, canned vegetables (unless labeled "no salt added"), frozen vegetables with sauces.
  • Starches: Salted crackers, pretzels, potato chips, cornchips, salted popcorn, salted nuts or seeds, etc.
  • Beverages: Buttermilk, tomato juice and vegetable juice (unless labeled "low sodium").
  • Condiments for use in moderation: catsup, prepared mustard, horseradish, sauces (barbecue, chili, and Worcestershire).
  • Condiments to avoid altogether: pickle relish, olives, garlic salt, onion salt, monosodium glutamate (MSG) (Accent), soy sauce, meat tenderizers, and salad dressings (unless homemade).
  • Salt substitutes are high in potassium and should only be used with your doctor's permission.

Potassium

Some drugs (cyclosporine or Prograf) can increase the potassium level in your blood. Other drugs (Lasix) can decrease your potassium level. When potassium is too high or too low problems with muscle and heart function can develop. Your serum potassium level can mandate a change to your medication and/or diet. High potassium foods include:

Fruits and Juices
  • Apricots
  • Melons
  • Prune juice
  • Avocados
  • Nectarines
  • Tomato Juice
  • Bananas
  • Oranges
  • V-8 Juice
  • Dried fruits
  • Orange juice
Vegetables
  • Leafy greens
  • Potatoes
  • Dried beans
  • Tomatoes
  • Pumpkins
  • Split peas
  • Lentils
Other Foods
  • Nuts
  • Chocolate
  • Peanut butter
  • Milk and dairy products