It's important for your child to eat a healthy diet after receiving a kidney transplant. Good eating habits help prevent health complications from post-transplant medications.
A healthy diet can:
- Keep blood sugar levels within normal limits, which prevents diabetes. Blood sugar can go up after a transplant.
- Keep blood cholesterol levels within normal limits, which keeps the heart healthy. Cholesterol levels can become elevated after a transplant.
- Prevent excessive weight gain. Some patients gain too much weight after a transplant.
- Help keep blood pressure normal directly after the transplant, through appropriate salt intake.
- Provide enough calcium to keep your child's bones strong and support growth. Patients taking prednisone after transplant need more calcium.
Planning a healthy diet
A healthy diet meets the following guidelines:
Low in sugar
- Limit juice, soda and other high-sugar drinks to less than 8 ounces a day.
- Limit candy and dessert-type foods to one serving or less a day. Read labels to determine how much of the food is considered a serving.
- Don't add sugar to foods or drinks such as cereal and tea.
- Choose low-sugar versions of healthy foods, such as regular milk instead of chocolate milk or plain yogurt instead of flavored yogurt.
Low in fat
- Limit butter, margarine, red meat, fried foods, poultry skin, bacon, sausage, full-fat dairy products, eggs, mayonnaise and junk food.
- Choose skinless poultry and fish more often than red meat.
- Serve red meat no more than three times a week. Choose cuts with "loin" or "round" in the name and keep serving sizes to 3 to 4 ounces of cooked meat. Cut all visible fat from the meat and discard.
- Choose low-fat or nonfat dairy products.
- Choose low-fat or nonfat versions of dressings, dips and spreads, such as margarine, mayonnaise, salad dressing and sour cream.
- Limit foods like chips, crackers and cookies. Try baked or low-fat versions of your favorites.
High in fiber
- Serve fiber-rich foods such as fruits, vegetables, whole grains, legumes and lentils.
- Serve two to four pieces of fruit a day. Choose fruit instead of juice. A serving of fruit is equal to a small or medium-size piece or 1/2 cup.
- Serve three to five servings of vegetables a day. A serving is equal to 1/2 cup cooked or raw vegetables or 1 cup raw leafy vegetables.
- Provide whole grains every day. The goal is three servings a day or more of whole wheat bread, pasta, couscous, tortillas, pita bread, oatmeal, wheat or oat cereals. Look for whole wheat flour instead of enriched wheat or enriched white flour on the ingredients list. Try grains such as quinoa and amaranth.
- Serve beans and lentils three times a week or more. You can serve them plain or add them to salads, stir-fries, soups, chili and burritos.
Moderate in sodium
Although the recommended limit varies with age, most patients should get no more than 1.5 to 2 grams (1,500 to 2,000 milligrams) of sodium a day. Use the food labels to help guide you. One teaspoon of salt equals 2,400 milligrams of sodium. In most cases, this restriction can be relaxed four weeks after transplantation. Talk with your child's dietitian for guidance.
- Limit the amount of salt you add to food during cooking. Use herbs, spices, lemon juice or vinegar to flavor foods instead.
- Don't use a salt shaker at the table.
- Limit salty foods such as chips, crackers, french fries, lunch meats and hot dogs.
- Limit processed foods such as frozen meals, processed cheese, sauce or powder flavor packets for noodles or rice, soups and canned vegetables. Processed foods often contain large amounts of salt.
Adequate in calcium
Try to meet your child's calcium needs with foods. Supplementation may be necessary but isn't appropriate for all patients. Talk with your child's doctor and dietitian for guidance.
Great sources of calcium include milk, yogurt, cheese and calcium-fortified beverages such as soy milk and orange juice – each has about 300 milligrams per serving. (A serving is equal to 8 ounces of milk or yogurt or 1 ounce of cheese.) Dark green vegetables, such as spinach and broccoli, are also good sources of calcium.
The recommended daily intake of calcium varies by age:
1 to 3 years old – 400 to 600 milligrams
4 to 8 years old – 800 to 1,000 milligrams
9 to 18 years old – 1,300 to 1,500 milligrams
There is no longer a restriction on potassium, phosphorus, protein or dairy intake after a transplant. This applies to patients who were on a protein-restricted diet before the transplant as well.
Some patients have low levels of potassium, phosphorus and magnesium in their blood. These patients often need supplements to raise blood levels of these minerals. In addition to supplements, your child should eat foods rich in these minerals.
- Fruits. Bananas, cantaloupe, dates, dried apricots, honeydew melon, kiwi, mango, nectarine, oranges, papaya, prunes, raisins
- Protein-Rich Foods. Chicken, flank steak (lean), halibut, peanuts, peanut butter, red snapper, salmon, sole, trout, tempeh, tofu, turkey
- Cereals. All Bran cereal, bran flakes
- Vegetables. Artichoke, avocado, cabbage, spinach, tomato, tomato juice, vegetable juice
- Starchy Vegetables. Potato with or without skin, sweet potato, yam, winter squash
- Beans and Legumes. Black-eyed peas, kidney beans, lentils, lima beans, refried beans, pinto beans
- Dairy Products. Milk, yogurt
- Dairy Products. Cheese, custard, frozen yogurt, ice cream, milk, pudding, yogurt
- Protein-Rich Foods. Beans, chicken, eggs, fish, lentils, nuts and peanut butter, red meat, pork, turkey
- Other Foods. Caramel and chocolate (limit portion and frequency because of their sugar content)
- Grains and Cereals. 100 percent bran cereal, bran flakes, brown rice, oatmeal (instant or regular), soybean flour, wheat germ, whole wheat bread
- Beans and Legumes. Black beans, kidney beans, lima beans, navy beans, pinto beans, refried beans, lentils
- Protein-Rich Foods. Almonds, beef, cashews, fish, peanuts and peanut butter, poultry, sunflower seeds, tofu, walnuts
- Vegetables. Avocado, beet greens, broccoli, okra, spinach, swiss chard
- Starchy Vegetables. Potato with skin
- Fruits. Bananas, figs, pineapple, raisins
Controlling weight gain
Patients taking glucocorticoids (prednisone) after kidney transplantation often have very large appetites and can feel hungry all day. This can lead to eating larger portions and eating more often than usual, causing weight gain.
Although children who are still growing should continue to gain weight, they should avoid gaining too much weight too fast.
To control weight gain:
- Follow all the healthy diet guidelines outlined above.
- Monitor portion sizes. Portion sizes vary from child to child and are somewhat dependent on age. Work with your child's dietitian to determine appropriate amounts for your child, but in general:
- Keep meat, chicken and fish to 3 to 4 ounces cooked or less – the size of a deck of cards or a woman's palm.
- Keep servings of starches such as pasta, rice, oatmeal, cereal, bread or tortillas to about two servings per meal. One serving is equal to 1/2 cup pasta, rice or oatmeal; 3/4 to 1 cup dry cereal; 1 slice of bread; or 1 6-inch tortilla.
- Offer lots of vegetables. Vegetables are very low in calories but high in fiber, which helps you feel full.
- Provide one to two snacks a day to keep your child from getting too hungry and overeating at meals. Choose low-fat and low- to moderate-calorie snacks such as fruits and vegetables. Don't offer junk foods like candy, chips or sweets.
- Encourage your child to be active every day. Your child's doctor can tell you what kinds of activities are allowed after transplant.
- Remember that usually, the more fat a food contains, the more calories it contains.
- Ask your dietitian for a handout on ways to modify recipes to reduce their calorie count.