Graft-Versus-Host Disease in the Gut: 5 Phase Diet
What is Graft-Versus-Host Disease?
It is called GVHD for short. This means the cells you got through transplant are attacking your body. This can cause problems with your gut (GI tract).
What are the symptoms of GVHD in the gut?
-
Nausea or vomiting
-
Poor appetite
-
Belly cramps or diarrhea
Why do I need this special diet?
Gut problems can make it hard to get all the nutrition you need. On this diet, you will slowly bring foods back into your diet. This will give your gut the time it needs to heal. A dietitian will help you throughout the process.
Here’s how the 5 phase diet works.
Phase 1 – gut rest
For this phase, you will not eat or drink by mouth. You will get all your nutrition through an IV line. This will give your gut time to heal.
Phase 2 – start drinking approved liquids
Start by drinking 2 ounces every 2-3 hours. 2 ounces is 1/4 of a cup. You will still get the IV feeding. If your symptoms do not get worse, you may drink a little more. But if you get worse, go back to phase 1.
You may choose any of these to drink:
Phase 3 – start solid foods
Keep drinking as allowed in Phase 2. You will also eat 1 solid food every 3 to 4 hours. The idea is to eat small meals often. If your symptoms do not get worse, you may add another solid food to your next meal. But if your symptoms get worse,go back to phase 2.
You may choose any of these:
-
Low fat, lactose free milk: Soy, Rice, Almond
-
Eggs: Scrambled or boiled
-
Meat: Chicken or turkey breast without skin (bake, broil, or boil)
-
Low fat fish: Cod, flounder, haddock, halibut, sea bass, or water-packed tuna
-
Fruits: Applesauce, washed banana, canned peaches or pears, grape juice, or commercial strained puree fruit (baby food)
-
Vegetables: Canned and well-cooked beets, carrots, green beans, peeled potatoes, or commercial strained puree vegetables (baby food)
-
Rice and pasta: Plain white rice; plain macaroni, spaghetti, or egg noodles
-
Breads: White bread, toast, or rolls; saltine crackers
-
Cereals (You may eat cereal dry or with lactose free milk.): Cream of wheat or grits made with water; puffed rice, Rice Krispies, Cornflakes, Special K, Frosted Flakes, Cheerios
-
Fats and oils: Margarine or mayonnaise – only 3 teaspoons per day (eat a little each meal throughout the day)
-
Soups: Low fat broth, chicken noodle soup, or chicken and rice soup
-
Sweets: Gelatin, fruit ice, jelly, or hard candy
-
Drinks: Decaffeinated coffee and tea, caffeine free sodas, or fruit drinks
-
Supplements: Gatorade or Powerade, Ensure, Boost, Resource Breeze, Pediasure Peptide
-
Seasonings: salt or sugar
Phase 4 – add some fat, fiber and lactose
The goal is to slowly add a little fat, fiber and lactose (sugar in dairy products) back into your diet. Some people cannot handle lactose. Others will need a lactase supplement. Foods with more fat can be added slowly, one at a time. You cannot have caffeine.
Add 1 food item from the list below. Make sure your gut can handle it. If your symptoms do not get worse, keep eating that food and add another at the next meal.
Once you can handle Phase 4 foods, you will stop getting nutrition through an IV line.
In addition to all of the foods listed above, you may choose any of these:
-
Lactaid milk or lactase supplement with cow’s milk
-
Beef, pork, chicken, fish, peanut butter
-
Cereals: You may eat cereal dry, with lactose free milk, or use lactase with milk.
-
Sweets: Sugar or peanut butter cookies, vanilla or yellow cake, angel food cake
Phase 5 – get back on a regular diet
As your symptoms get better, move on to the low bacteria diet. All allogeneic stem cell patients should follow this diet.
Add 1 food item at a time from the list below. Make sure your gut can handle it. If your symptoms do not get worse, keep eating that food and add another at the next meal.
In addition to all of the foods listed above, slowly add these foods back into your diet:
-
Foods or drinks with caffeine
-
Foods with lactose: cheese, milk, or ice cream – you may also need lactase
-
Roasted nuts
-
High fiber foods: whole wheat bread and cereals, cooked berries, or dried beans
-
Cooked veggies high in fiber: broccoli, celery, cauliflower, greens, or corn
-
Foods that cause gas: pinto or dried beans, cooked onions or broccoli, or washed and peeled cucumbers
-
Foods with acid: washed and peeled citrus fruits and juices (such as oranges or lemons), canned pineapple, washed and peeled or cooked tomatoes and tomato products
-
Foods that may bother your gut: chocolate, caffeine, spices, garlic, or cooked peppers
For any other questions or concerns about your diet, please ask to speak with your Registered Dietician.