Diet and physical activity long-term after a liver transplant
This information leaflet is for people who have had a liver transplant. It explains the following:
- A balanced diet
- Food labelling
- Healthy weight
- Physical activity
- Eating for a healthy heart, cancer prevention and strong bones
When recovering from transplant more energy, protein and a good intake of vitamins and minerals are needed to help heal surgical wounds. Therefore it is important to continue with a high energy and protein diet. When your wounds are healing well, your appetite is good and you are not losing weight without meaning to, it is important to start eating a healthy diet and increase physical activity.
After your transplant you will have to take immunosuppressive medications for example tacrolimus, ciclosporin, sirolimus, mycophenolate mofetil, azathioprine and prednisolone. These reduce the activity of your immune system in order to help prevent your new liver being rejected. Your immunosuppressant medication is very important for your body to not reject your new organ(s). However people who take immunosuppressant medications are more vulnerable to:
- Osteoporosis (brittle bones)
- Cardiovascular disease, including heart disease and stroke
Lifestyle choices described in this leaflet, including your diet, activity levels and being a healthy weight, can help to reduce the risk of these health problems.
The Eatwell guide, on page 3, shows the different types of foods that make up our diet and the proportions of them we should eat over the day.
The key to achieving a healthy diet is to get the balance right:
- Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates. Choose wholegrain, brown or wholemeal instead of refined or white carbohydrates.
- Eat at least five portions of fruit and / or vegetables per day.
- Include protein-rich foods with two meals per day, including a portion of oily fish each week.
- Aim for three portions of dairy or dairy alternatives with calcium added (such as soya drinks and yogurts) per day. Choose lower-fat and lower-sugar options.
- Choose unsaturated oils and spreads in small amounts.
- Eat foods high in fat, salt and sugar only occasionally and in small amounts.
- Drink plenty of fluids, aim for six to eight glasses / cups a day
- Many retailers and manufacturers now provide ‘at a glance’ nutritional information on the front of food packs. For example, many are now using traffic light colours to show you whether a food has high (red), medium (amber) or low (green) amounts of fat, saturated fat, sugars and salt per 100g or per portion.
- Foods with a red label should only be eaten occasionally, foods with an amber label are fine to eat most of the time and those with a green label are the healthiest choices to choose as often as possible. Most foods will have a mixture of red, amber and green but when you are choosing between products, pick those with greens and ambers as much as possible.
For your height, your ideal weight range is:
______ kg to ______ kg
_____ stone, ____ pounds to _____ stone, ____ pounds
If your weight is much above or below this, it is advisable to aim to reach or work towards your ideal weight range. Being overweight increases your risk of cancer, heart disease, stroke, high blood pressure, diabetes and fatty liver. Carrying your weight around your middle further increases this risk. Being underweight can increase your risk of infections and osteoporosis.
Some people experience weight gain and become overweight or obese after a liver transplant.
There are many reasons why people gain weight following their transplant including:
- Improvement of general wellbeing and appetite.
- Steroid medication (for example prednisolone), which can increase appetite.
- Reduction in physical activity levels following transplant.
- The challenge of changing from a ‘high energy, little and often eating’ diet, needed before and immediately after liver transplant, to a ‘healthy’ diet, needed in the long run after liver transplant.
If you are not within your ideal weight range and would like advice to achieve this, please contact your dietitian.
Regular physical activity is important to stay healthy after a transplant. It reduces the risk of heart disease, stroke and cancer and can help to improve mood and sleep.
When you have recovered from your transplant it is advisable to start with gentle physical activity, such as walking, swimming, cycling and yoga and gradually increase the pace and intensity to achieve the recommendations below. You may only be able to do very gentle activity for short periods of time to start with, which is normal after a liver transplant. Start with the activity you can do, little and often, and build on this as your strength and stamina improves.
There are different types of physical activity: cardiovascular, strengthening and weightbearing. All are required to stay healthy after a transplant. Activity can be incorporated into your daily routine, for example walking the dog, taking the stairs, playing with the children/grandchildren or parking further away and walking for the last part of your journey.
Adults should do:
- At least 150 minutes (two hours and 30 minutes) of moderate-intensity activity (i.e. cycling, fast walking or jogging) in total every week. This can be split up into shorter durations, such as 10 minutes three times a day, for five days a week. Moderate activity will raise your heart rate and make you breathe faster and feel warmer.
- Strengthening activity on two or more days a week that works all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms). Examples of muscle-strengthening include lifting weights, working with resistance bands, exercise that lifts or pushes your own body weight such as yoga and gardening such as digging.
- Weight-bearing physical activity is particularly important in improving bone strength and helping prevent osteoporosis. Any activity where your feet and legs support your weight is weight-bearing. Examples include running, walking, racket sport, skipping, dancing, aerobics or even jumping up and down on the spot. Weight-bearing activities count towards the 150 minute activity recommendation above.
Contact your transplant team if you would like more advice about physical activity.
Eating for a healthy heart, cancer prevention and strong bones
5 A DAY is based on advice from the World Health Organisation, which recommends eating a minimum of 400g of fruit and vegetables a day. Benefits of eating at least 5 A DAY include:
- Getting vitamins and minerals.
- Getting dietary fibre, which helps maintain a healthy gut and prevent constipation or other digestion problems.
- Reducing the risk of heart disease, stroke and cancer.
To get the most benefit from your 5 A DAY, the five portions should include a variety of fruit and vegetables. This is because different fruits and vegetables contain different combinations of fibre, vitamins, minerals and other nutrients. Almost all fruit and vegetables count towards your 5 A DAY. They can be fresh, frozen, canned, dried or pure juices. Potatoes and cassava don't count because they mainly contribute starch to the diet. Aim for 5 x 80g portions per day.
Limit processed and red meat
Processed meat has been preserved by smoking, curing, salting or adding other chemical preservatives. It includes all types of bacon and ham as well as some sausages like hot dogs. It also includes popular sandwich fillings such as salami, corned beef and pepperoni. Eating processed meat increases the risk of bowel cancer.
Red meat includes beef, lamb and pork and can form part of a healthy diet. But eating a lot of red meat probably increases your risk of bowel cancer. It is advisable to limit red meat to 500g cooked weight (700g raw weight) per week. This could be three meals with 150g or six meals with 80g of red meat. Try using poultry, fish or vegetarian sources of protein such as beans and pulses to replace red meat.
Cut back on salt
Eating too much salt increases the risk of heart disease, stroke, cancer and osteoporosis (weak bones).
It is recommended you have no more than 6g salt per day, which is the equivalent of a teaspoon. You don't have to add salt to your food to eat too much of it – around 75% of the salt we eat is already in everyday foods, such as bread, breakfast cereal and ready meals.
Top tips for reducing salt:
- Stop adding salt to your food at the table.
- Use food labels to help you choose lower salt options (see food labelling above).
- During cooking try an alternative flavouring to salt, for example, black pepper, basil, parsley, garlic, chives, vinegar or lemon juice.
- Watch out for cooking sauces and seasonings, like soy sauce and jerk seasoning, these are very high in salt.
- Swap salty snacks such as crisps and salted nuts with fruit and vegetables instead.
- Avoid saltier foods such as bacon, cheese, take-aways, ready meals and processed foods.
- Reduce fat and change the type of fat you are eating
- Fat is the most energy dense nutrient we eat, so cutting down on the amount of all types of fat eaten can help to prevent weight gain or help to achieve weight loss.
Reduce fat and change the type of fat you are eating
Fat is the most energy dense nutrient we eat, so cutting down on the amount of all types of fat eaten can help to prevent weight gain or help to achieve weight loss.
To help keep your heart and blood vessels healthy and reduce the risk of stroke and heart disease it is recommended to:
- Cut right down on saturated and trans fats and replace them with monounsaturated fats and polyunsaturated fats. Trans fats come from hydrogenated vegetable oil, which must be declared on a food's ingredients list.
- Aim for one portion of oily fish per week. Examples of oily fish include: herring, salmon, trout, anchovies, mackerel, pilchards, sardines and kippers. A portion is 140g.
If you have high cholesterol and would like to follow a cholesterol lowering diet, please contact your dietitian.
Non-urgent advice: Saturated Fats
- Hard cheese
- Whole milk
- Fatty meat
- Coconut oil
- Palm oil
Non-urgent advice: Trans Fats
- Fried foods
- Hard margarines.
Foods that have ‘hydrogenated oils or fats’ or ‘partially hydrogenated oils or fats’ in the list of ingredients are likely to contain trans fats.
Replace saturated and trans fats with:
Non-urgent advice: Monounsaturated Fats
- Olive oil and rapeseed oil
- Nuts and seeds (almonds, cashews, hazelnuts, peanuts and pistachios)
- Some spreads are made from monounsaturated fats, such as olive oil and rapeseed
Non-urgent advice: Polyunsaturated Fats
- Corn oil, sunflower oil and soya oil
- Nuts and seeds (walnuts, pine nuts, sesame seeds and sunflower seeds)
- Oily fish such as herring, mackerel, pilchards, sardines, salmon, trout and fresh tuna
- Some spreads are made from polyunsaturated fats, such as sunflower oil.
There are two types of fibre - insoluble and soluble. Soluble fibre is partly absorbed into the blood and research has shown that it can help reduce cholesterol levels. Sources include beans, pulses, fruit, vegetables and oats.
Insoluble fibre remains in the digestive system and makes stool (poo) more bulky which promotes regular healthy bowel movement. Sources include the skin of fruit and vegetables, nuts and wholemeal, brown and wholegrain cereal, rice, bread, flour and pasta. Fibre can be filling and low in fat, which may be helpful if you are trying to lose weight.
Calcium is important to keep bones strong. Sources of calcium are described in the table below. Aim to include three to four good sources calcium in your diet each day.
Sources of Dietary Calcium
|Good Source||Moderate Source|
|Dairy||Good Source Milk and milky puddings, yogurt, Cheddar/Edam/Parmesan, cheese, custard, ice cream||Moderate Source Cottage cheese|
|Non-Dairy||Good Source Milk, yogurt or dessert with calcium to them, such as: soya, oat, rice, nut, coconut. Tinned pilchards/sardines, whitebait, tofu||Moderate Source Tinned salmon/crab, prawns, mussels, fish paste, baked beans, red kidney beans, sesame seeds, almonds, brazil nuts, hazel nuts, white bread, white pita bread, oranges, tangerines, apricots, currants, figs, blackcurrants, broad beans, broccoli, cabbage, curly kale, spring greens, watercress|
Vitamin D is needed for the gut to absorb calcium from the diet. Sunlight is normally our main source of vitamin D but you are advised to cover up from the sun following your transplant. There are few dietary sources of vitamin D so it is very difficult to get enough from food. It is recommended that you have 10 micrograms (µg) or 400 international units (IU) of vitamin D each day from a supplement to prevent deficiency, which is available from supermarkets and chemists. Some patients may be prescribed a higher dose by their doctor to treat deficiency, this may be alone or in combination with calcium. Please check with your doctor or pharmacist if you are unsure if you are already prescribed vitamin D. It is important not to take high doses of vitamin D as this can cause renal stones and calcification of blood vessels.
Further information can be found at the following websites:
- The British Heart Foundation: www.bhf.org.uk/
- NHS Choices www.nhs.uk/livewell
- The Eatwell Plate: www.nhs.uk/Livewell/goodfood/Pages/the-eatwell-guide.aspx
- Fat: the facts: http://www.nhs.uk/Livewell/Goodfood/Pages/Fat.aspx
- Cholesterol lowering diet: https://heartuk.org.uk/cholesterol-and-diet/about-the-uclp
- Fitness and exercise: http://www.nhs.uk/LiveWell/Fitness/Pages/Fitnesshome.aspx
If you have any queries, please do not hesitate to contact your dietitian.
Department of nutrition and dietetics, liver transplant dietitians – 01223 216655
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