Healthy eating with your kidney transplant · Gaining weight can be beneficial if you are...

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Healthy eating with your kidney transplantFor kidney (renal) patients

Information for patientsSheffield Dietetics

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Introduction

Following your kidney transplant, the levels of waste products, minerals and fluid in your body may vary depending on how well the transplanted kidney is working. For this reason, you may have to either limit or increase your intake of some foods. Your blood results will determine whether or not you need to change your diet. The transplant nurse on the ward will discuss your blood results with you.

If you are unsure about your diet after reading this booklet please ask to see a renal dietitian or contact us on 0114 271 4162. We can discuss your diet with you by telephone or we can arrange to see you in clinic.

If your transplanted kidney works well you may no longer need to follow dietary and fluid restrictions. You can therefore eat a wider variety of foods and follow general healthy eating advice.

This booklet will show you the variety of different foods to eat in suitable portions to help you achieve a healthy balanced diet.

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Why is it important to follow a healthy balanced diet?

People with a kidney transplant are at a higher risk of developing certain conditions, as listed below. A healthy balanced diet and regular exercise can help you to reduce this risk. It is important to keep as fit and well as possible.

Weight gain

Weight gain can be a common problem after a transplant. This may be due to an unrestricted diet. It could also be linked to an increased appetite due to some of the medicines which you may need to take, for example the anti-rejection drug (steroid) Prednisolone.

Being overweight increases your risk of developing health problems such as high blood pressure, heart disease and diabetes.

What if I am underweight?

Gaining weight can be beneficial if you are underweight. If you have had a poor appetite or a reduced food intake you may find that your intake increases after your transplant, which will help you to gain weight. If, however, you would like to have information on increasing your intake, please discuss this with the doctor in renal clinic who will refer you to a renal dietitian.

Cholesterol

Your cholesterol levels may rise following a kidney transplant which increases the risk of heart disease and stroke. The rise in cholesterol is a side effect of some of the anti-rejection medicines that you need to take. You may be able to improve your cholesterol level by following a healthy diet as described in this booklet and medications may also be prescribed.

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Steroid-induced diabetes and impaired glucose tolerance

Steroid-induced diabetes and impaired glucose tolerance are conditions where your body is unable to fully control your blood glucose levels and both can be possible side effects of taking steroids. You must continue to take steroids as directed by your doctor as they help to stop your body rejecting your new kidney.

It is important that you know how to control your blood glucose level because a high blood glucose level can make you feel very thirsty and may make you prone to infections. Following a healthy balanced diet as described in this booklet can help you to control your blood glucose level, but you may also need further dietary information from a dietitian.

Your blood glucose levels, weight and cholesterol levels will be monitored in clinic. You will be referred to a dietitian if needed.

Osteoporosis

Osteoporosis is a condition which weakens the bones and increases your risk of a fracture (broken bone). A diet which contains enough calcium as part of a healthy balanced diet can help guard against this. Other ways to help prevent osteoporosis include stopping smoking and being physically active.

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What is a healthy diet?

The Eatwell guide below shows you how much of what you eat should come from each food group to achieve a healthy balanced diet. Try to choose a wide variety of foods from each of the groups.

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Fruit and vegetables

Fruits and vegetables are high in fibre and low in calories. They also contain lots of vitamins and minerals which are important for a healthy body.

• Eat at least 5 portions a day.• A portion is around 80g, for example 1 banana, apple or orange,

2 plums, 1 slice of melon, 1 cupful of grapes, 1 small glass (200ml) of fruit juice, 1 bowl of salad or 2- 3 tablespoons of vegetables.

• Choose fresh, frozen or canned.• Cook vegetables lightly or serve raw in salads.• Try to include a portion of vegetables or salad with your lunch and

evening meal.• Try adding beans and lentils to casseroles and soups.

Potatoes, bread, rice, pasta and other starchy carbohydrates

These are the body's main energy sources and contain important vitamins and fibre.

• Include a portion of starchy carbohydrate foods with every meal.• If you are overweight try to avoid adding fat to these foods.• Choose wholegrain varieties of cereals and bread where possible

– Wholegrain foods are high in insoluble fibre which helps you to feel fuller for longer.

– High fibre cereals may also help to prevent constipation.– Soluble fibre found in oats and pulses may help lower blood

cholesterol levels.

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Dairy and alternatives

These include, milk, cheese and yoghurt. There are dairy free options of these foods which are made from soya or nuts such as almonds which can be a good addition to your diet. These foods are a good source of protein, vitamins and calcium. Calcium is very important for keeping your bones healthy and so if you are using the dairy free alternatives such as soya, you will need to buy a fortified version.

Before your transplant you may have restricted these foods to help control your phosphate levels; this is no longer necessary. Following a successful kidney transplant it is common for your phosphate level to become low so it is important to include foods from this group daily.

• Have 2 to 3 portions of dairy and alternatives a day, ensure that you choose pasteurised varieties.

• A portion is;– a matchbox-size (30g) piece of cheese– 1 small pot of yoghurt (125g)– 1 glass of milk (200ml)

Some dairy foods are high in fat, in particular saturated fat, which can raise cholesterol levels. This can increase the risk of heart disease.

• Choose low fat varieties where possible such as semi-skimmed or skimmed milk.

• Choose diet or light yoghurts as they are low in fat and sugar.• Try low fat cheeses such as Edam and Gouda.• Try cream cheese or cottage cheese in light varieties.• Try grating a stronger flavoured or mature cheese to make it go

further.

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Beans, pulses, fish, eggs, meat and other proteins

These foods are a good source of protein which is important for growth and repair of the body's tissues. They are also a good source of iron, zinc and B vitamins.

• Eat 2 portions a day.• A portion of cooked meat, poultry or oily fish is the size of a pack

of cards or 3oz (80g).• A portion of cooked white fish is 5oz (140g).• Aim to eat 2 portions of fish a week, including 1 portion of oily

fish, for example salmon or mackerel. These are a good source of heart-healthy omega 3 fats.

• A portion of peas, beans or lentils is 4 heaped tablespoons (80g).

Some meats are high in fat, in particular saturated fat, which can raise cholesterol levels. This can increase the risk of heart disease.

• Choose lean cuts of meat.• Trim the fat off meat and remove the skin from poultry before

cooking.• Try not to add fat or oil to meat when cooking.• Try eating white meat and fish more often.• Try soya or Quorn meat substitutes. These are naturally lower in

fat.• Include pulses such as peas, beans and lentils in casseroles, stews

and salads. These are much lower in fat.• Try poached or boiled eggs rather than frying. Try grilling and

baking rather than frying.

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Fatty and sugary foods

Examples of these foods include chocolate, sweets, cakes, biscuits and fizzy drinks. These foods contain large amounts of calories (energy) but not many other nutrients. These foods should be limited as part of a healthy balanced diet.

However, if you are underweight or have a poor appetite you may be advised by a dietitian to include more of these foods to prevent further weight loss.

Tips to help you cut down on sugar and fat

• Choose a low fat spread made from olive or sunflower oil instead of butter. Spread thinly or try without spread.

• Measure oils on tablespoons rather than pouring it from the bottle or try a spray oil.

• Drink fewer sugary drinks. Try diet or zero drinks instead.• Use less sugar in drinks, baking or added to breakfast cereals. Try

artificial sweeteners instead, for example Splenda, Canderel or Hermesetas.

• Choose fruit tinned in natural juice rather than syrup.• Instead of sweeter cakes, pies and chocolate try plain biscuits, tea

breads and malt loaf.• Swap to diet options when choosing puddings.• Choose high fibre and wholegrain cereals instead of sugar-coated

varieties, for example Weetabix, Shredded Wheat and Shreddies.

Fats

It is important that we eat a small amount of fat each day. Fat plays a role in many essential body functions, including the provision of essential fatty acids which the body is unable to make. It also allows your body to absorb some vitamins and provides a protective layer around essential organs.

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There are different types of fat, some of which are healthier for the body than others, but all should be limited to prevent weight gain and heart disease.

Saturated fats

These are mainly animal fats and are found in full fat dairy products, fatty meat and lard. A diet high in this type of fat increases the cholesterol level in your blood. This increases your risk of developing heart disease or having a stroke.

Monounsaturated fats

These are found in foods such as olive oil, rapeseed oil and products made from these oils. This type of fat can help to lower the harmful cholesterol in your blood, but should still be limited for a healthy balanced diet.

Polyunsaturated fats

These fats are found in vegetable oils, some nuts, seeds and oily fish. These fats help to lower the harmful cholesterol but still only use in moderation.

Trans fats

These fats are found naturally in small amounts in foods such as dairy and meat products and some other processed foods such as biscuits, cakes and pies.

A diet high in this type of fat increases the cholesterol level in your blood which increases your risk of heart disease.

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Salt

High blood pressure can remain a problem even after your kidney transplant. This can damage your new kidney as well as being linked to the risks of heart disease and stroke.

Too much salt can increase blood pressure, but it can be difficult to reduce as it is added to many manufactured foods. Most people have too much salt in their diet without adding salt to food at the table or in cooking.

• Adults should eat no more than 6g of salt per day, about 1 teaspoonful.

• Remember, 1g sodium is about 2.5g salt. The amount of salt in a product can be worked out by multiplying the amount of sodium by 2.5.

Tips to help you cut down on salt

• Use only a pinch of salt in cooking, or better still use none at all.• Do not add salt at the table.• Use herbs and spices to give flavour to your food, for example

vinegar, mustard, pepper, lemon juice, garlic, mint and apple sauce.

• Cut down on ready made meals and convenience foods as they can contain a lot of salt. Remember to check the label.

• Swap to lower salt alternatives, for example reduced salt gravy.• Cut down on very salty foods, for example:

– Tinned and packet soups– Tinned baked beans and spaghetti– Salted nuts and crisps– Foods in brine, for example vegetables and fish– Salty meat, for example bacon, sausage, salami and smoked

fish

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Guide to labels

Lots of supermarkets and food manufacturers now use a traffic light system to help you choose foods which are lower in fat, salt and sugar.

The different colours show you if the food has a high (red), medium (amber) or low (green) amount of fat, saturated fat, sugar and salt in 100g or 'per portion' of the food.

Choose foods labelled red only occasionally; foods labelled amber are fine to eat most of the time; those labelled green are the better choices. The more green labels, the healthier the choice.

All measuresper 100g

LOWa healthier

choice

MEDIUMOK most of

the time

HIGHjust

occasionally

Sugars

Total fat

Saturated fats

Salt

5g or less

3g or less

1.5g or less

0.3g or less

5.1 - 22.5g

3.1 - 17g

1.6 - 5g

0.31 - 1.5g

More than 22.5g

More than 17.5g

More than 5g

More than 1.5g

of an adult’s reference intake.

Check the label on packaged foods

Energy

1046kJ250kcal

3.0g 1.3g 34g 0.9g

15%38%7%4%13%

Low Low High Medium

Fat Sugars SaltSaturates

Each serving (150g) contains

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Alcohol

Government guidelines on alcohol recommend that you drink no more than 14 units of alcohol a week.

What is a unit?• Half a pint of ordinary strength beer or lager (3 to 4% ABV) is

1 unit• 1 single pub measure of spirit (25ml)• 1 standard measure of sherry (50ml)• 150ml of standard wine is 2 units

Advice about drinking alcohol• Spread your drinking throughout the week.• Have at least 2 days a week when you do not drink alcohol.• Avoid drinking heavily in a short space of time (binge drinking).• Remember, alcohol is high in calories so if you are watching your

weight keep alcohol intake to a minimum and choose spirits with diet mixers if you do decide to drink.

• Some medications can interact with alcohol. Always check with your doctor or pharmacist if it is safe for you to drink alcohol.

If you would like any further information or help with your diet please contact the renal dietitians on 0114 271 4162

PD6171-PIL1948 v5 Issue Date: May 2020. Review Date: May 2023

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Alternative formats can be available on request.Please email: [email protected]© Sheffield Teaching Hospitals NHS Foundation Trust 2020Re-use of all or any part of this document is governed by copyright and the “Re-use of Public Sector Information Regulations 2005” SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email [email protected]

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