Multivitamin and mineral supplements

[sofluoglu]

Hi,

I have been following the forums here for several months. It has been very useful for me to learn about others' experiences first hand. I am grateful for this opportunity.

We live in Istanbul, Turkey. My son who is 14 years old had an allo-BMT from her sister on February 4th due to being AML. He had GVHD mainly in skin and liver. He seems to be recovering slowly from that. Due to having Gvhd he has nutritional restrictions in content and preparation methods. I am worried whether he gets all the vitamins and minerals he needs. He has also lost about 20 pounds since the transplant despite having a good apetite. We began to get dietitian support with that.

Introducing multivitamin support would be an option to deal with vitamin deficiencies. Our doctor does not put much importance on this issue. I think it is a more delicate matter than it sounds. I don't want any extra strain on his body, yet I want him to gain strength.

Any recommendations and insights will be much appreciated.

Salih Ofluoglu

[Neil Cuadra]

Salih,

What are the nutritional restrictions on your son? What types of food were you told that he should avoid?

[sofluoglu]

Hi Neil,

Thanks for the reply. He is not allowed to eat any raw food. Everything has to be well cooked. Although getting better he has an occasional diarhea problem. We were told to avoid fruits and vegetable that induce diarhea, such as spinach, green lentil, apricot, prune etc. He is recommended to have a lactose and gluten free diet as much as possible. He was asked to avoid fatty food and sugar where possible due to the GVHD in his liver.

Salih

[Neil Cuadra]

Originally Posted by sofluoglu

Hi Neil,

Thanks for the reply. He is not allowed to eat any raw food. Everything has to be well cooked. Although getting better he has an occasional diarhea problem. We were told to avoid fruits and vegetable that induce diarhea, such as spinach, green lentil, apricot, prune etc. He is recommended to have a lactose and gluten free diet as much as possible. He was asked to avoid fatty food and sugar where possible due to the GVHD in his liver.

Salih

Salih,

I think you have two separate concerns:

1. Your son has dietary restrictions and you want to make sure he gets enough nutrition.

   Your son can get proper nutrition, even with the restrictions, if you pick the right foods and prepare them appropriately. It's harder to have a proper diet when you have restrictions, but many people (including vegetarians and vegans) learn the ways to keep their diet healthful.
   
   Since your son can't have raw food, consider using canned precooked fruits and vegetables. Also, there are ways to preserve vitamins while cooking; you an find tips on the Internet (example). If you look for these cooking advice sites you'll find recommendations such as steaming vegetables and keeping the lid on a pot while cooking.
   
   Even though raw food can be especially nutritious, avoiding raw food can reduce the chances of an infection. That was probably important in the first months after his transplant and less important now, but it's still nice to avoid infections.
   
   Since your son should avoid certain specific food (spinach, green lentil, etc.) make sure he gets a variety of other choices. This can help provide the best range of vitamins and minerals and also make it less boring. If he gets bored with the restricted diet, remind him that it should be only temporary.
   
   You should review all of these ideas with the dietician and ask if your son still needs vitamin supplements.
   
   Since your son is not eating fatty food and sugar he probably has a healthier diet than most 14-year-olds!

2. Your son has lost 20 pounds.

   If your son lost 20 pounds and is continuing to lose weight then I'd talk to both the doctor and dietician about it. If he lost 20 pounds (maybe because he's not eating junk food!) and then stayed at that weight then I would be less concerned.
   

[sstewart09]

Do you have access to nutritional drinks like Ensure? They are great for short term. They might raise his glucose levels, but our drs always preferred the calories.

[sofluoglu]

Dear Neil and Samantha,

Thanks for the tips indeed.

The weight loss issue has been less concerning. He seems to go stable with his current weight for the past two months. His appetite is OK. The food portion size he consumes is considerably smaller though. We add protein and carbohydrate powders to his meals to compensate it.

As you also pointed out my son also likes junk food and eating out like most of his peers. He is also quite talented at cooking the recipes he makes up. We are doing our best to diversify his choices of nutrition. During GVHD providing a picky adolescent with a balanced nutrition in natural ways is really challenging sometimes. Anything less than normal dissappoints him. We constantly remind him that it is a temporary situtation. Including the chemos he has been on and off a varying restrictions on his diet for more than a year. He runs out of patience. Hopefully, when his GVHD eases off his restrictions will be gradually lifted.

As for the nutritional drinks, yes we have tried several types of those. I think they taste OK, but my son does not like them. Thanks for the suggestion.

Salih

[dfantle]

Hello Salih,I'm happy to hear your son seems to be doing quite well following his BMT. Regaining the weight may take a little time still especially since you mentioned he needs to limit fatty foods. Is your son having healthy snacks between meals? If not, I would recommend he have several throughout the day, but not so much that they reduce his apetite at meal time.

My stem cell transplant was Jan 29 & I am still working to try and regain the 10lbs I lost. Although I am able to have fatty foods, I'm trying to regain with healthier foods so its taking longer, so far I've just regained 2 lbs.

[sofluoglu]

Hi Dena,

Thanks for your recommendations. I hope that everthing goes well with you too.

We serve him organic fruit/vegetable juices made with boiled ingredients twice a day. He also likes homemade cookies, cheese pastries, cereals, french fries and milk puddings with minimal sugar and fat. We try to make some of those available depending on his mood!

Salih