When you’re dealing with GVHD, maintaining a healthy weight is critical to helping your body recover. “Our weight status helps set the stage for our immune function,” says Margaret Martin, RD, CDCES, the manager of nutrition education at the Leukemia & Lymphoma Society (LLS) who is based in Nashville, Tennessee. “When our body weight is healthy, it supports all of the other physiological functions, including our digestion.” But it can be difficult to maintain a healthy weight after a bone marrow transplant. “Poor nutrition and poor body weight, as well as a loss of muscle mass, can increase the risk of developing GVHD,” says Michelle Bratton, RD, a nutrition educator with the LLS’s PearlPoint Nutrition Services and specialist in oncology nutrition who is based in Tucson, Arizona. In addition, people who develop GVHD symptoms in the digestive tract can become malnourished. “We eat to fuel our bodies and give them the energy that they need to do even basic things. When that is lacking in people with GVHD, it can markedly impact their quality of life in a negative way,” says Bratton. “GVHD can prevent or decrease the absorption of nutrients, calories, and hydration, which can cause weight loss, malnutrition, and other complications,” adds Martin.
Diet Tips to Help Ease Common GVHD GI Symptoms
Some GVHD GI symptoms can be treated with medications, but there are also many ways to help manage these issues through diet.
Diarrhea
GVHD attacks the lining of the digestive tract and can disrupt the nerves that move food and drinks through the body. “Diarrhea can be caused by the ineffective absorption of nutrients and fluids, and instead of it taking 24 to 72 hours to digest food, it rushes through,” says Martin. To minimize its impact, follow a clear liquid diet, which includes items such as broth, ginger ale, and diluted juices without pulp. “This is a nutrition plan that allows your gut to heal so all those good digestive cells can regenerate and grow,” says Martin. It’s also good to opt for room-temperature food and drinks, which are easier to absorb, and to eat small amounts every two hours. Lying down can also help slow your digestion. “After you feel better, you can also eat soft foods like rice, applesauce, bananas, toast, and soft pretzels to help your body start to process easy-to-break-down foods,” she adds. If you have ongoing diarrhea, it’s important to get enough sodium and potassium in your diet; good sources are broth, fruit juices, sport drinks, potatoes, and bananas. You can also make your own electrolyte replacement drink at home: Mix ¼ teaspoon of salt, 8 teaspoons of sugar, 3 tablespoons of orange juice concentrate, and 4 cups of water, according to the LLS.
Nausea and Vomiting
For people with GVHD, nausea and vomiting are common problems, according to Bratton. “Eating small, frequent meals throughout the day is very important, as is minimizing liquids while you eat,” she advises. Stick to room-temperature fluids in between meals. If you’re sensitive to smells and someone is cooking in the house, take a walk outdoors. And while lying down is good for diarrhea, sitting upright is better for nausea to help move foods into the small intestine. Make sure you’re taking your anti-nausea medications as you’ve been instructed. “If you are, you might want to ask your healthcare team if there’s a medication they can add on or change. Finding that right kind of cocktail of anti-nausea meds can really work wonders sometimes,” Bratton adds.
Mouth Sores
Mouth sores are annoying and painful but often can be managed with simple techniques. Choose soft, moist foods, such as mashed potatoes or oatmeal, over those with a dry, rough texture, such as toast or tortilla chips, Bratton suggests. When possible, choose lukewarm or cold foods over hot ones. If you’re limited in what you can eat, drink milkshakes or smoothies so you can get adequate calories and protein. “Getting those nutrients in is really important to heal those sores,” she adds. You can also make your own mouthwash by mixing one quart of water with one teaspoon of baking soda. Frequently swish with it and spit it out. “If you’ve followed some of these tips and the pain is still limiting your ability to eat, your physician may be able to prescribe pain meds that help numb the tissues in the mouth,” Bratton says.
Dry Mouth
Alcohol and tobacco products can worsen dry mouth, so it’s best to avoid them, says Bratton. Instead, keep your mouth moist with gum, ice chips, ice pops, or hard candy. There are also over-the-counter moisturizing sprays for easing dry mouth, but you may have to use them frequently, she adds.
Weight Loss
Although we’re bombarded by messages about how healthy it is to lose weight, it’s not good when you’re dealing with GVHD. “Think about what you eat that works well, which you can digest with the least amount of discomfort,” Martin suggests. Think about when you naturally tend to be hungriest and eat more at that time, whether it’s at breakfast or later in the day. “Plan to eat more to match that hunger,” Martin says. When you eat, choose higher-calorie foods first, such as proteins and starches, followed by vegetables and fruits. You can also bump up the calories in your meal without having to make an extra dish by adding “calorie boosters”: butter, margarine, vegetable or olive oil, sour cream, maple syrup, melted cheese, chopped meat, gravy, and sauces.
Taste Changes
Many people struggle with taste changes when dealing with GVHD. A common complaint is that meat tastes bitter, says Bratton. “You can marinate it in something a little sweeter like a teriyaki sauce,” she suggests. If you’d rather skip meat altogether, try other protein sources, such as cottage cheese or yogurt. “There is not one strategy that can ameliorate all taste changes. Using strategies like marinating meats and choosing foods that taste better can help you meet your nutrition needs until the taste changes subside, which can be after treatment is done,” Bratton says. Dry mouth can also cause taste bud changes. “When you’re able to manage dry mouth, taste can actually improve,” Martin says.
Other Nutrition Tips for GVHD
These strategies can also help you manage GVHD and its symptoms:
Eat smaller, more frequent meals. This is key to keeping yourself fueled and recovering. Since you can’t rely on your appetite to tell you when to eat, you can make a schedule for eating and drinking every few hours or set reminders on your phone to eat at certain times.Prioritize food safety. “Follow the food safety guidelines of your transplant center to minimize the risk of foodborne illness,” says Bratton.Focus all your recovery efforts on nourishing your body. “Ask your family to pitch in on other things, like doing the laundry, cooking, shopping, so you can focus on making sure you’re well nourished,” Martin suggests. You could also set up a Meal Train for your neighbors, friends, or church group and let them know the kinds of foods you’re able to eat.Track your eating habits. You can download the LLS Health Manager™app to keep track of your food and beverage intake or use a worksheet, if you’d rather write it down on paper. This can help your doctor understand what you’re eating and if other interventions may be necessary, says Martin.
Your transplant center may have had you meet with a dietitian before your transplant. If you haven’t met with one, you can ask someone on your treatment team to refer you to a dietitian who works with transplant patients to help troubleshoot your symptoms. LLS also offers free nutrition consultations by phone for patients with any type of cancer as well as caregivers. You can schedule a consultation using the online scheduler or call (877) 467-1936. You can also call an LLS information specialist at (800) 955-4572 for personalized support, financial information, and community.
