This booklet has been designed to give you detailed information about nutritional concerns you may have before, during and after your stem cell transplant.
This booklet aims to address the following areas
Prior to admission for transplant ensure that you have a general healthy balanced diet and a healthy weight.
Research suggests that better nourished patients have a shorter time to engraftment and better tolerance of their treatment.
It is important that you are not experiencing weight loss, or be of low body weight prior to admission, if this is happening please ask your consultant to refer to you to the specialist dietitian for advice.
It is important that you try to eat as much nutritious food as you can, to help fight infection, tolerate your treatment and improve your strength.
Nutritional assessment
When admitted to C10, C9, U3 or Haematology Day Unit for your transplant you will be assessed by a dietitian who will look at the following:
- Weight assessment
- Height assessment
- BMI assessment
- Review of any weight loss
- Dietary history review
They will also discuss the following:
- Clean diet
- Foods from home
- High protein diet and provision of oral nutritional supplements
- Provision of artificial nutrition support during treatment
Menus
We do try to provide patients with adequate choice with various menus to prevent the need for families to bring food in. Patients/ ward staff must discuss any concerns with ward dietitian before allowing food to be brought in for the patient.
The menu contains at least one spicy meal option each day to cater for those with taste changes.
Snacks and food from home
Menus on C10 and U3 contain foods that are acceptable when neutropenic.
C9 have a different meal service but this is still coded to help adherence to the neutropenic diet.
Snacks such as biscuits, cakes, toast, breakfast cereals, yoghurts and cheese and crackers are available on the ward at all times for patients to request. All snacks on the ward are individually package and are therefore safe for neutropenic patients. There is also an extra choices menu to allow patients to order extra snacks and desserts for between meals. There is a specific extra choices list for neutropenic patients.
Small tubs of ice cream and iced smoothies are also kept on the ward for patients to have at any time of the day. These are useful for patients with mucositis as it can help to relieve some of the pain, both are safe to eat when neutropenic.
Food from home
Relatives and friends can bring snacks, such as individually wrapped cakes, biscuits and sweets as well as crisps onto the ward for patients.
All patients are advised to have snacks that are individually wrapped to prevent cross contamination and reduce their risk of food borne infections.
If patients are struggling with hospital meals and wish meals to be brought in from outside the hospital, it is advisable that they are frozen meals that can only be stored for 24 - 48hrs on the ward and reheated once.
Patients must sign a disclaimer to indicate their understanding of risks of heating food on the ward.
All food items must have a label with your name, hospital number and date it was brought in attached before putting it in the ward fridge/freezer.
Oral nutritional supplements and artificial feeding
Oral nutritional supplements
During your inpatient stay your appetite and oral food intake may decrease you may be started on oral nutritional supplements such as Fortisip compact protein, fortijuce or scandishake.
These are used to improve your nutritional intake to help provide energy and protein to maintain energy levels and prevent muscle loss.
Artificial feeding
Due to prolonged periods of reduced appetite and mucositis (sore mouth) you may be unable to meet your needs by eating foods and taking supplements. If this happens, it may be necessary to place a feeding tube to provide your nutrition.
Your ward Dietitian will be able to explain these in more detail and advice on the most appropriate route for feeding.
As part of some treatment regimens the placement of a feeding tube will be automatically arranged due to expected side effects of treatment.
The risks and benefits of each form of artificial feeding will be discussed with you by the Dietitian and the most appropriate form of artificial feeding commenced if necessary.
Neutropenic diet
Due to the high dose chemotherapy you will receive when undergoing stem cell transplants, you will experience significant immune suppression.
Neutropenia is defined as a neutrophil count of < 0.5 x 109/l or < 1.0 x 109/l with a predicted decrease to 0.5 x 109/l.
The following table highlights foods that you will need to avoid and gives alternatives foods for periods of neutropenia.
| Avoid | Alternatives |
|---|---|
|
Avoid
All unpasteurised dairy products e.g. milk sold on local farms |
Alternatives
Any pasteurised milk, soya milk, Jersey milk or UHT milk |
|
Avoid
Soft cheeses made with unpasteurised milk e.g. feta, parmesan Homemade/deli paneer and labnah Mould-ripened cheeses e.g. Camembert, Brie, goat’s cheese Blue veined cheeses e.g. Danish blue, Blue Stilton |
Alternatives
Cheeses made with pasteurised milk, processed cheese e.g. Dairylea, Kraft, Philadelphia, mesh and halloumi White Stilton Pasteurised parmesan, pasteurised mozzarella. Paneer made with pasteurised milk Vacuum-packed pasteurised and hard cheeses e.g. cheddar and Edam |
| Avoid Damaged/ bruised/ over-ripe Fruit/vegetable |
Alternatives
Fresh fruit, vegetables and salad – including prepacked Salad and fruit. Ensure all above are well washed before eating Raw dried fruit, products containing these e.g. muesli, Bombay mix, confectionary Fruit juices/ smoothies Tinned or frozen fruit and vegetables Cooked dried fruit e.g. in fruitcake, flapjacks or cereal barsFresh fruit, vegetables and salad – including prepacked Salad and fruit. Ensure all above are well washed before eating Raw dried fruit, products containing these e.g. muesli, Bombay mix, confectionary Fruit juices/ smoothies Tinned or frozen fruit and vegetables Cooked dried fruit e.g. in fruitcake, flapjacks or cereal bars |
| Avoid Raw or lightly cooked shellfish |
Alternatives
Well-cooked shellfish e.g. prawn Curry |
|
Avoid
Raw/undercooked meat, poultry or fish e.g. meat which is still pink, caviar and oysters Avoid smoked salmon unless eaten directly from a freshly opened packet |
Alternatives
Well cooked meat, poultry and fish; tinned meat and fish Vacuum-packed cold meats such as turkey and ham stored below 3°C and eaten following the manufacturer’s instructions Vacuum packed fish eaten straight from a new packet. This includes smoked salmon. |
|
Avoid
Raw eggs or undercooked eggs e.g. homemade mayonnaise, homemade ice cream, mousse, egg-nog, meringue, Hollandaise sauce and béarnaise. Any dressing containing raw eggs e.g. home/restaurant-made Caesar salad dressing |
Alternatives
Hard boiled eggs; shop-bought mayonnaise and other products made with pasteurised egg |
|
Avoid
Unnecessarily large packets of food items from pick and mix, universal jars Deli counter foods e.g. olives, shawarma and baklava |
Alternatives
Ideally, packets should be individual portions e.g. butter, sweets, pickles Prepacked olives |
| Avoid Ice when away from home e.g. in a restaurant and slush puppies | Alternatives Ice made from appropriate water sources |
| Avoid Ice cream from ice cream vans | Alternatives Ice cream from reputable sources, individual portions, wrapped, small pots |
|
Avoid
Non-drinking water, or spring water, water from wells, water from coolers, domestic water filters and water fountains |
Alternatives
Freshly run tap,mineral/ carbonated water Please check with your hospital for guidance |
Post-stem cell transplant dietary advice
Although you may no longer be neutropenic after your transplant, your immune system still takes time to recover fully. In addition, if you have had a stem cell transplant from a donor (allogeneic transplant), you will also be taking immunosuppressant drugs. During this time you may be more vulnerable to infection.
The following guidelines will help to reduce the risk of infection and subsequent food poisoning from harmful bacteria.
Shopping
- Avoid buying foods with damaged packaging or dented tins.
- Avoid buying bruised fruit and vegetables.
- Avoid shops where cooked and raw meat is not separated.
- Buy meat and fish from shelves and cabinets that look clean and are not overloaded.
- Try to buy chilled and frozen foods last. Get them home and stored in the fridge or freezer as quickly as possible.
- Always eat food within the 'Use By' or 'Best Before' date.
Storage
- Ensure the temperature of your fridge is between 0 and 5°C and your freezer is below -18°C.
- Raw meat and defrosting food should be stored in covered dishes or containers, which catch drips.
- Raw foods should be stored separately from cooked foods.
- Store cooked foods at the top of the fridge and raw foods at the bottom.
- Cover all food in the fridge.
- Never re-freeze thawed food.
- Do not overload the fridge or freezer as this will increase the temperature
- Eggs should be stored in the fridge
Food preparation
- Wash your hands properly with soap and water.
- Cover all cuts and grazes.
- Keep pets out of the kitchen.
- Bleach, disinfect or change kitchen cloths often. Disinfect worktops often especially when raw meat or poultry has been prepared.
- Wash and dry utensils and chopping boards between preparing raw and cooked food to avoid cross- contamination.
- Wash all fresh fruit and vegetables before preparation.
- Wipe cans before opening them.
Cooking
- Cook meat, poultry, shellfish and eggs thoroughly.
- Processed meat products like burgers and sausages should be cooked until the meat juices run clear.
- Follow manufacturers' guidelines. Cooking times on food labels and in cookery books should not be shortened. Always pre-heat the oven.
- Thaw meat and poultry thoroughly in the fridge and not at room temperature.
- Do not re-heat foods more than once.
- Always heat until food is piping hot.
- If using a microwave, follow the instructions on cooking and standing times. Know the power rate of your microwave.
Eating away from home
Discuss with dietitian and transplant team when it is safe for you to consume takeaways.
- When eating out or having a take-away, always ensure food is well cooked and piping hot.
- Eat from reputable establishments.
- Avoid food sold from street vendors, market places, salad bars and ice-cream vans.
| Food | Avoid | Alternatives |
|---|---|---|
| Food Cheeses |
Avoid
Soft and ripened cheeses for example Brie, Camembert, Feta • Blue cheeses for example Stilton, Danish Blue • Fresh/frozen cheese cake |
Alternatives
Hard cheeses - Cooked or individually wrapped, for example, Cheddar, Red Leicester. Cut off any visible rind. • Processed cheeses for example Philadelphia, Dairylea, Kraft Singles and Cottage Cheese |
| Food Meats and fish |
Avoid
Raw fish for example sushi. • Raw or lightly cooked shellfish • Rare meats, for example steak tartar, pate. • Meat or fish from delicatessen, smoked items e.g. salmon, Parma ham and salami. |
Alternatives
Well-cooked fresh, frozen, tinned fish and meat. • Well-cooked shellfish e.g. prawn curry • Tinned, bottled pate, paste. • Ready-made cook/freeze, cook/chill meals. Always follow manufacturers’ instructions |
| Food Eggs |
Avoid
Raw or cracked eggs • Dishes containing raw or undercooked eggs, for example homemade mayonnaise, mousse, Hollandaise sauce, egg nog or meringue. |
Alternatives
Well-cooked boiled egg, scrambled. • Fried omelette – well-cooked. • Shop bought mayonnaise in tin/jar (not 'deli' style). |
| Food Dairy Products |
Avoid
• All unpasteurised dairy products • Probiotic yoghurts and drinks• All unpasteurised dairy products • Probiotic yoghurts and drinks |
Alternatives • Pasteurised milk, cheeses and yoghurts including live yoghurt, Greek / natural yoghurt. |
Post-stem cell transplant - Eating at home
The restrictions discussed in the previous pages may need to be continued after you are discharged from hospital.
Following an autologous transplant we aim for you to be eating a normal balanced diet with no restrictions after 3 months post-transplant.
If you have had an allogeneic transplant you will be discharged on immune suppression medications such as Tacrolimus or Ciclosporin and will need to continue these restrictions until the doctors have stopped these particular medications.
The Dietitian will be able to advise you on these restrictions if you have any specific questions.
The ward dietitian is always happy to discuss any concerns you may have regarding food and snacks during your hospital admission and can be contacted prior to your admission.
Notes
Dietitian: Natasha Jones
01223 216 655
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Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.
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