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Treatments & Procedures

Nutrition after Bone Marrow Transplant

Good nutrition is a very important part of your recovery. It helps your body resist infection and repair tissue damage caused by chemotherapy and/or radiation therapy.

Losing interest in food after a long illness is to be expected. Some of the side effects you might have experienced while in the hospital may continue even after you go home. These side effects may include nausea, vomiting, loss of appetite, taste changes, and a sore or dry mouth. With these symptoms, it may be difficult for you to imagine eating high-calorie, nutrient-rich meals.

Nutrition supplements

When you are unable to eat a well-balanced diet, we recommend you try over-the-counter nutrition supplements to meet your nutritional needs, unless otherwise instructed. Examples of nutrition supplements are Ensure®, Boost®, Resource®, Carnation Instant Breakfast®, Boost® bars and Boost® puddings. If you have diabetes, Choice DM® and Glucerna® are options.

Multivitamins

We recommend you take a daily multivitamin, after you are discharged. You can take children’s chewable multivitamins twice a day if better tolerated. Excess doses of some vitamins and minerals might be unsafe at this time. For instance, it is important to choose vitamins that do not contain iron or herbs. Also, due to your numerous red blood cell transfusions, additional iron supplementation is unnecessary. Your body does not eliminate iron. If you have questions regarding your preferred multivitamin, bring your labeled vitamin bottle to your appointment for your doctor’s approval.

Follow food safety guidelines when choosing any of the following foods:

Calcium and Phosphorus

Some of your medicines might deplete calcium, which is important for maintaining bone strength. When the staff reviews your medications and labs, they will inform you if this is likely to be a problem. Phosphorus is a mineral that helps to strengthen bones. Some bone marrow transplant patients often need additional phosphorus. Unless you are following a special diet, we recommended you eat a diet high in calcium and phosphorus.

Dairy products high in calcium and phosphorus include:

  • Creamer (pasteurized)
  • Milk (skim, low-fat, whole)
  • Natural cheese, processed cheese (pre-packaged)
  • Cottage cheese, ricotta cheese
  • Yogurt (regular or frozen)
  • Pudding, custard
  • Ice cream or ice milk
  • Cream soup
  • Buttermilk
  • Evaporated milk
  • Powdered milk

Non-dairy products high in calcium include:

  • Calcium-enriched fruit juice
  • Roasted almonds
  • Dried peas and beans (cooked thoroughly)*
  • Tofu (calcium enriched, cooked thoroughly)
  • Greens (kale,collard, mustard, turnip*)
  • Canned salmon with soft bones
  • Broccoli*
  • Bok choy
  • Spinach
  • Mackerel
  • Sardines*
  • Shrimp

*a good source of phosphorus

Additional foods with significant amounts of phosphorus:

  • Brussels sprouts
  • Peanut butter
  • Beef and Chicken livers
  • Whole grain breads
  • Coconut
  • Chocolate
  • Avocados
  • Chick peas
  • Nuts
  • Mushrooms
  • Artichokes
  • Tropicana Fruit Punch®
  • Hawaiian Punch®
  • Tropicana Peach Papaya®
  • Tropicana Strawberry Melon®
  • Fruitworks -- all varieties except pink lemonade
  • Cool Iced Tea -- all varieties except lemonade iced tea

Your doctor might recommend calcium supplements such as Tums®, Oscal +D®, or Caltrate®. Calcium supplements with vitamin D are essential for those who require long-term steroid therapy, such as prednisone. Steroids cause bone loss, called osteoporosis. Taking these supplements, as well as exercising, can help minimize bone loss and prevent fractures. An appointment with a rheumatologist may be advised to monitor your bone density.

Potassium and magnesium

Antibiotics, diarrhea, and vomiting can cause electrolyte (mineral) imbalances. Even after your hospital discharge, it is common to require potassium and magnesium supplementation, which can be given by pill or intravenous infusion.

Potassium is an electrolyte (mineral) that maintains normal fluid balance, supports cell integrity, facilitates the making of protein, assists in the transmission of nerve impulses, and the contraction of the heart and other muscles.

Fruit sources of potassium include:

  • Apricots
  • Avocados
  • Bananas
  • Dates, figs
  • Honeydew/cantaloupe
  • Oranges
  • Peaches
  • Prunes
  • Raisins

Vegetables high in potassium include:

  • Artichokes
  • Bamboo shoots
  • Beans
  • Beets
  • Chard
  • Chick peas
  • Escarole
  • Leeks
  • Mushrooms
  • Spinach
  • Squash
  • Tomatoes
  • White potatoes, sweet potatoes

Magnesium is also an electrolyte (mineral) that is involved in bone mineralization, building of protein, transmission of nerve impulses, and normal muscular contraction.

Significant sources of magnesium include:

  • Legumes
  • Leafy green vegetables
  • Nuts
  • Milk
  • Whole grain cereals
  • Chocolate
  • Meat
Sodium

Sodium is an electrolyte essential for water regulation and electrical activities of the body, such as nerve impulse transmission and muscular contraction. Our diets rarely lack sodium. A healthy person requires about 200 mg of sodium daily, but the average sodium intake is estimated to be 6,000 to 18,000 mg daily. Excessive sodium intake can lead to high blood pressure (hypertension) and fluid retention. Reduce your sodium intake to less than 2,300 mg each day.

Since allogeneic bone marrow transplant recipients might already be experiencing hypertension or fluid retention/swelling (edema) caused by steroids —such as prednisone, tacrolimus (Prograf®), or cyclosporine (Neoral®) — it is crucial to avoid a diet high in sodium.

Alcohol

After your bone marrow transplant, you might have decreased liver function due to the effects of high-dose chemotherapy, graft-versus-host disease (GvHD), or metabolism of medicines. Since the liver metabolizes alcohol, avoid all alcoholic beverages. Alcohol can cause malnutrition by attacking the stomach lining, leading to malabsorption and excretion of many nutrients. Before drinking beer, wine, or other alcoholic beverages, ask your BMT doctor.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/15/2012...#4382