Food Avoidances & Herbal Remedies After Transplant - ITNS Alberta

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Food Avoidances & Herbal Remedies After Transplant - ITNS Alberta

Food Avoidances &

Herbal Remedies After

Transplant

Grace Hubert, RD

Clinical Dietitian

Islet, Heart, Lung and Pancreas after Islet

Transplant Programs


What we will cover:

Safe use of herbal & nutritional

supplements

Too much or not enough?

– Calcium & vitamin D

Update on food-medication

food medication

interactions

Too much or not enough?

– Protein


Herbal Supplements

Natural does

not mean safe


Natural Health Products

2004 Health Canada Regulations

– All products require a license before sale

in Canada

– Products reviewed by Health Canada

(ingredients, source, potency,

recommended use)

– Given a license number (NPN)

– Adverse reactions must be reported


Herbal Supplements & Transplant

Transplant Proceedings 43, 2935-2937

2935 2937

(2011)

(2011) Dietary Supplements & Herbal Preparations in

Renal & Liver Transplant Recipients

– 58% use , but includes 36% vitamin & mineral

supplements

– 15% use diuretic herbs

– 15% use herbs regulating the digestive

tract

– 11% use sedative herbs

– 9% use purgative herbs

– 6% use slimming herbs

– 4% use immunostimulating herbs

– 3% use herbs for facial problems

– 3% use herbs for improving respiratory

function


Why is this a concern?

Documented interactions include, but are

not limited to:

– Lower levels of immune suppression resulting

in rejection

– Kidney or liver failure

– Increased bleeding

Comprehensive Natural Medicines

Database – available to AHS health

practitioners

– Includes specific adverse events of each herb

with references


Herbal Supplements & Transplant

Immune suppressing

– Can suppress the immune system too

much when combined with anti-

rejection medication

– Includes:

Ipriflavone

Thunder god vine

More than 3 grams fish oil


Herbs that may increase

immunosuppression levels

Kava German chamomile

Quercetin Bishop’s Bishop s week

Peppermint oils Devil’s Devil s claw

Red clover Eucalyptus oil

Resveratrol Evodia

Valerian Feverfew

Wild Cherry Fo-ti Fo ti

Siberian ginseng Guggulsterones

Berberine


Nephrotoxic Herbs

Acorus calamus Rue

Alder buckthorn Creatine

Aristolochia clematitis Chromium picolinate

Autum crocus Echinacea

Bao Gong Ten Fish gallbladder

Birch bark/leaf Glucosamine

Bird flower Magnoliae officianalis

Birthwort Marking nut tree

Cancer bush Chinese yew

Cape Aloe Sephania tetranda

Cat’s Cat s claw Ysterhouttoppe


Nephrotoxic Herbs

Hemlock Spanish fly

Hydrazine sulfate Spurge

Impila Star fruit

Khat leaf Takaout Roumia

Licorice Thunder God Vine

Ma Huang Wild wisteria

Morning Cypress Wormwood oil

Oduvan Yam

Pennyroyal Yellow oleander

Propolis Chaparral

Rhubarb Geranium

Sheep bile Lysine

Bladderwrack Sobi-lobi Sobi lobi

Willow bark


Herbs that increase risk of bleeding:

– Omega 3

– Goji berries

– Garlic supplements

– Bilberry

– Cayenne

– Feverfew

– Ginkgo

– Reishi

– Don Quai

– Sativum

– Danshen


Black root

Blessed thistle

Celandine

Chapparal

Chasso

Comfrey

Gremander

Gordiloba yerba tea

Glue thistle

Valerian

Viscum alba

Hepatotoxic Herbs

Leopiota Helveola

Ma Huang

Mate teaonshido

Margosa oil

Mistletoe

Pennyroyal oil

Rue

Sassafras

Skullkap

Squaw vine


Artemesia

Atractylis gummifera

Borage

Bush tea

Callilepsis laureola

Coltsfoot

Crotalaria

Heliotropium

Kombucha mushroom

tea

Licorice root

Soapwort

Sofara

Hepatotoxic Herbs

Symphytum

Tansy rafwort

Tonkabean

Tropical periwinkle

Woodruff

Yohimbe

Mellot

Life root

Groundsel

Indigo

Jin Bu Huan

Kava


Other factors to consider:

Herbal medicines may have:

– Contamination

E.g. E.g. bladderwrack grown in contaminated

water containing arsenic & heavy metals

– Erroneous identification or preparation

E.g. E.g. death campus looks similar to wild

onion

Identification Identification requires a skilled botanist

Reference: Acute Kidney Injury Associated with the use of

Traditional Medicines Nature Clinical Practice

Nephrology 2008 Vol 4 No 12 p 664


ALL herbal supplements

should be reviewed with

physician, dietitian or

pharmacist before use.


Calcium Supplements & Heart

Post Transplant:

Disease

– Vitamin D 1000 units (or amount

required to maintain normal level)

– 1200 to 1500 mg calcium/day

– E.g.: 3 cups milk/yogurt/day = 900 mg

multivitamin 180

amount from non-dairy non dairy foods = 300 mg

Total 1380 mg


Calcium

Excessive calcium supplement

(not calcium from diet) associated

with:

kidney stones

prostate cancer

Possible association with heart attack

and stroke


Check www.osteoporosis.ca for

content of calcium in foods

If you have sarcoidosis, please check

with your physician or dietitian

before starting calcium or vitamin D

supplements.


Food-Medication Food Medication Interactions

Grapefruit products:

– Interferes with tacrolimus, sirolimus,

cyclosporin, everolimus

– Increases absorption by as much as

60%

Increases Increases drug effects

Can Can cause toxic levels

– Variability in grapefruit

composition


Eliminate Grapefruit intake

Grapefruit family:

Pomello

Tangelo

Seville orange

Bergamot

Always check label of juice or fruit

blends


Avoid Fresca (contains grapefruit)

Avoid marmalade (may contain

grapefruit, Seville oranges or

bergamot)

Similar effect seen with star fruit


Tea

Chamomile, bergamot (found in earl

grey tea or may be an ingredient in

other teas), dandelion and licorice

– May interact with Cyclosporine,

Cyclosporine ,

Tacrolimus Tacrolimus and Sirolimus

Sirolimus

– Use in moderation or not at all

Try mint tea or plain tea


Pomegranate

Not Not enough evidence on

pomegranate:

–Has Has been shown to impact other

drugs that are metabolized the

same way as tacrolimus, sirolimus

and cyclosporin

–No No effect in healthy volunteers

–No No studies that look specifically at

immunosuppression


Protein

Protein plays a key role in health

Cells & tissue – growth & repair

– Muscles, bones, organs

– Blood protein/clotting factors

– Antibodies

Hormones & enzymes

Fluid balance

– Albumins & globulins


Too little protein in the diet:

Osteoporosis

– Loss of bone

Sarcopenia “poverty poverty of flesh” flesh

– Loss of muscle mass, strength &

function

– Body wt may or may not change

But But more fat tissue

– Muscle mass is a predictor of mortality

later in life


Too much protein in the diet:

If the kidneys are not working

properly, extra protein is risky

So how much is “just just right”? right

What about timing? Why can’t can t I be

like a camel?

Nutrition & Metabolism 2009: 6:12 Layman, D


Protein Requirement


Pick the most balanced breakfast:

a) 2 slices toast, 2 tsp margarine, 1

Tbsp jam, coffee

b) Blueberry muffin, coffee, 2 eggs

c) 1 cup Cheerios, 1 cup 1% milk,

½ cup grapes

d) 1 cup 1% milk, 1 scoop whey

protein, ½ cup strawberries

e) 2 slices Squirrely bread, 2 Tbsp

peanut butter, 1 cup milk, 1 orange


Protein

Aim for 20-30 20 30 grams protein/meal

(less if you have kidney failure)

Breakfast is often low & supper is

often excessive

– re-distribute re distribute the protein

Don’t Don t forget about lunch

– Bread products/noodles are often low

Breakfast protein ideas?


Protein content – check label

1 cup milk or yogurt: 9 g

¾ cup Greek yogurt: 17 g

1 egg: 6-7 6 7 g

30 g cheese: 7 g

2 Tbsp/30 ml peanut butter: 6-9 6 9 g

1 scoop whey protein: 25-30 25 30 g

Squirrely Bread 2 slices = 10 g

Vector cereal 1 ¼ cup = 5.5 g


Protein content

Cottage Cheese ½ cup = 15 g

¼ cup almonds (35g): 8 g

¼ cup hummus: 4 g

¾ cup kidney beans: 10 g

75 g meat/fish: 30 g


Websites

*note note these are NOT specific to transplant

www.pulse.ab.ca

www.flaxcouncil.ca

www.canolainfo.org

www.chicken.ab.ca

www.albertabeef.org

www.eggs.ab.ca

www.LeslieBeck.com

www.cemcor.ubc.ca

www.LeslieBeck.com CTV dietitian

www.cemcor.ubc.ca Centre for

Menstrual Cycle and Ovulation Research

www.dietitians.ca

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