NUTRITION AFTER BONE MARROW TRANSPLANT Abibat Gbadamosi Specialist Haematology Dietician Royal Free NHS Trust

Overview Importance of Healthy Eating Balanced Diet Food safety Nutrition related symptoms of BMT GVHD

Importance of Healthy Eating Eating well will help maintain or regain your strength, have more energy and reduce your risk of new cancers Will help fight infection Prevent weight loss Prevent nutrient deficiencies Improve mental state Improve quality of life Reduce hospital stay

Balanced Diet

Starchy Food Bread, cereals, pasta and potatoes Provide energy for the brain and muscles Wholegrain varieties is high in roughage and good for the bowel

Fruit and Vegetables Aim for 5 portions of fruit and vegetables/day Can be fresh, frozen, tinned or dried Good source of fibre, vitamins and minerals, vitamins A, C, and E and antioxidant Lower risk of heart disease and prevent constipation Fibre can help reduce cholesterol

Meat, fish and alternatives Meat, fish, chicken, eggs, beans, tofu, quorn and nuts Good sources of protein and iron Include these foods twice a day Eat less processed meat: sausages, bacon, salami, tinned meats and packets meat Eat more fish, chicken, turkey and pulses

Milk, Diary & Alternatives Milk, cheese, yoghurt, fromage frais, dairy alternatives Good source of calcium Source of protein Aim for 3 portions a day A portion is 1/3 pint milk, 150g yoghurt, 25g cheese

Foods High in Fat and Sugar Fat is required e.g. absorption of fat-soluble vitamins (vitamins A, D, E & K) Small amounts allowed daily (e.g. spreading fat, cooking oils, oil based salad dressings) –choose unsaturated fats Limit ‘hidden fats’ & ‘added sugars’ to occasions only - examples..? Choose low fat/low sugar versions where possible

Food Safety Wash your hands before preparing meals Wash raw vegetables and fruits Always check the use by dates on packaging Store cooked food at the top of the fridge Do not reheat cooked rice For home-cooked foods, cool food at room temperature within an hour after cooking and then refrigerate or freeze Eating out – choose reputable outlets. Avoid salad bars, street vendors, market stalls and ice cream vans

Loss of Appetite Eat small meals more often. Snack between meals and at bedtime Concentrate on making your meal more enjoyable: attractive settings, pleasant music, and good company. Adjust the seasonings and flavourings in your food to accommodate taste changes. Rely on your favourite foods when your appetite is diminished. Prepare foods that are pleasing to your sense of smell and taste to stimulate appetite.

Reducing Bloating Chew foods more slowly to avoid becoming too full too quickly. Try 4-6 small meals instead of 3 large meals. Drink less during the meal. Drink minutes before or after eating. Avoid carbonated beverages Stop eating when you feel uncomfortable. Take a walk to increase circulation and to help release any gas.

Nausea and Vomiting Be sure to take your anti-nausea medication as prescribed by your doctor. Eat dry foods like biscuits, toast, crisps, and bread sticks Try to maintain your fluid intake by drinking a variety of fluids including water and salty fluids like broth. You may need to drink 1⁄2 to 1 cup fluid after a vomiting episode. Do not lie down flat for at least two hours after eating. Small, frequent meals may be tolerated better Avoid foods that are greasy, fried or overly sweet

Dry /sore mouth Experiment with different textures of foods, making them softer and easier to chew and to swallow. Some soft foods include mashed potatoes, cottage cheese, scrambled eggs, puddings, sorbet, puddings, yogurt, milkshakes. To moisten foods, add extra gravy, butter, margarine and sauces or cream soups to the foods. Avoid very dry foods such as crackers and toast. Try sucking on ice cubes, lollies or boiled sweets Speak to your doctor about numbing agents such as lozenges or sprays or moistening agents such as “artificial saliva” Sipping liquids throughout your meal may help relieve a dry mouth.

Gut GvHD You may need to make changes to your diet: Low fat: Fats are hard to digest & can increase diarrhoea Low fibre: Certain fibres can increase diarrhoea or gas e.g. insoluble fibres such as whole wheat products Low lactose: Dairy products contain lactose - that may be hard to digest during GI illness. Signs of poor digestion are bloating, gas, abdominal cramping & diarrhoea choose lactose free milk, avoid soft cheese, choose hard cheese Low acid / irritant food – avoid spices, chillies, fizzy drinks, too much fruit juice Low caffeine Ask to see a dietitian