Q: My husband has had a kidney transplant 6 months back and is now gradually getting back his energy though his feet and ankles swell up very often. He is on immunosuppresant drugs. Is it all right for him to have a vodka (alcohol) occasionally as now he is tempted to get back to sipping hard drinks? His transplant was done in Pakistan. I need some guidance about his food intake as he tends to eat too much.

A:The diet aims to provide adequate calories, protein & foods to maintain good nutritional status, manage the nutritional side effects of immunosuppressive therapy, mitigate weight gain and promote good blood sugar control. Up to 1 Month post-transplant: The patient should take 1.3-1.5 g protein/kg body weight, may need sodium/potassium and/or fluid restriction and may require phosphorous supplementation. A diabetic diet should be resumed (if the patient is diabetic) . After 1 month post-transplant: The goal is to manage the nutritional side effects of immunosuppressive therapy (prednisone & cyclosporine). Prednisone causes increased appetite, breakdown of muscle tissue, sodium retention (which may increase blood pressure), glucose intolerance (which increases blood sugar), increased levels of cholesterol & triglycerides and decreased calcium and phosphorus levels. Cyclosporine may lead to increased blood pressure (limit sodium), increased BUN (restrict protein only if absolutely necessary), increased potassium (may need K restriction) and diarrhoea (which may be a major concern). Diet becomes more liberal as medicines are weaned over time. Nutritional issues involved pertain to weight gain, increased protein needs, elevated blood sugar, raised cholesterol & triglycerides, elevated blood pressure, elevated potassium, decreased calcium & phosphate and fluid intake 1) Weight gain: The average weight gain is about 10-20% in the first two years due to: resolution of anorexia due to uremia, appetite stimulation from medicines, freedom from restrictive renal diet and sedentary lifestyle. 2) Elevated blood sugar due to steroid-induced diabetes. If already diabetic, causes problem thus, watch weight gain. 3) Increased protein needs: These are required to heal after surgery and to build/repair tissue and daily requirement is 1.0-1.2 g/kg of body weight with 75-80% of it being of high biological value like eggs, all meats, milk & cheese. Consuming grains, starch, legumes and vegetables is fine. 4) Elevated cholesterol & triglycerides: Coronary artery disease is the main long term problem in transplant patients. Thus, reduce saturated fat intake and watch excessive weight gain but diet alone may be ineffective. 5) Elevated blood pressure: It may exist prior to transplant and post-transplant may be caused by medicines. Restrict salt to 2 g/day. 6) Decreased calcium & phosphate: Mobilised from bones due to medicines or previous poor kidney function. One must consume milk and dairy products daily and these may need supplementation. 7) Fluid Intake: Adequate fluid should be consumed (> 2 L/day) so that kidney is put to work. A drink per day is acceptable.