Life with chronic graft-versus-host disease (GVHD) often means dealing with painful mouth sores, nausea, diarrhea, and gut discomfort, which can make eating challenging. These symptoms of GVHD can affect how well your body absorbs nutrients, which makes maintaining a healthy weight challenging.
While diet isn’t a cure for GVHD, your food choices, along with the treatments prescribed by your healthcare team, can reduce inflammation, avoid digestive system (gut) irritation, and decrease the risk of infection. It’s always best to discuss any dietary changes with your healthcare team first.
As you build your diet while managing chronic GVHD, consider avoiding or limiting the following foods.
1
Unpasteurized Milk, Cheeses, and Juice
Unpasteurized products, such as raw milk and cheeses, can carry harmful bacteria like Listeria, says Taylor Janulewicz, RDN, the founder and dietitian at My Cancer Dietitian. Other dangerous germs found in raw milk include Salmonella, E. coli, and Campylobacter. Some juices, especially fresh-squeezed varieties from juice bars, may also be unpasteurized.
Since GVHD and its treatment can weaken your immune system, it’s important to avoid unpasteurized products to reduce the risk of infection, says Gabrielle Haskell, RD, a clinical oncology dietitian at OSF HealthCare Cancer Institute. Instead, choose pasteurized dairy products and juices. Pasteurization is a process where the product is heated to a specific temperature for a short period to kill harmful bacteria without affecting its taste or nutritional content.
Look for the word “pasteurized” on the label to confirm that the product has undergone this process, says Janulewicz. If you’re unsure, ask the store clerk, especially if you’re buying from a farmer’s market or a local stand where the pasteurization process may not be clearly labeled.
2
Raw or Undercooked Meat and Eggs
Raw or undercooked meat and eggs may carry dangerous bacteria that can pose serious risks to people with weakened immune systems, says Janulewicz. Even mild foodborne illness (food poisoning) can become life-threatening for people living with GVHD, she says.
Haskell advises avoiding raw or undercooked foods, especially if you’re taking immunosuppressive medications (medications that weaken your immune system to prevent it from attacking your body). This includes foods like sushi with raw fish, rare or undercooked poultry or meat, and runny eggs. Some homemade foods, like cookie dough, can contain raw eggs.
To stay safe, cook all meat and eggs thoroughly. Use a food thermometer to make sure eggs are cooked to at least 160 degrees F (71.1 degrees C), and follow the recommended safe cooking temperatures for meat. When eating out, be mindful of dishes that may contain raw or undercooked ingredients and opt for fully cooked food options to reduce the risk of infection.
13 of the Best Foods for Chronic GVHD
Easy to digest and packed with nutrients to aid recovery and manage symptoms, these 13 foods are some of the best for managing GVHD.
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3
Citrus and Other Acidic Foods
Mouth sores from chronic GVHD can be painful. In some cases, your mouth may feel dry and sensitive, and you may develop painless blisters on the roof of your mouth. Certain acidic foods, like orange juice, lemons, limes, grapefruits, and tomatoes, can worsen that discomfort, says Haskell.
It’s not just fruits — certain condiments and dressings can also exacerbate your symptoms. Vinegar-based products, like mustard, ketchup, soy sauce, barbecue sauce, and salad dressings, can irritate mouth sores and the gut when GVHD symptoms are active.
Try limiting acidic foods, diluting citrus juices with water, or opting for low-acid varieties. For cooking, consider using herbs and mild spices rather than acidic condiments to add flavor to your meals without the potential for irritation.
4
Hot Peppers
Spicy foods can be just as troublesome as acidic ones, especially if you’re already dealing with a sore mouth or digestive issues. Ingredients like capsaicin, found in hot peppers, can irritate the gut and worsen symptoms like cramping and diarrhea, says Janulewicz. It’s best to avoid meals heavily seasoned with chili powder, cayenne, jalapeños, or hot sauce.
“Stick to mild seasonings, especially during active symptoms,” says Janulewicz. Herbs like basil, oregano, and thyme can add flavor to your meals without causing irritation. Also, softer, bland foods that are served lukewarm or cool can soothe your mouth and throat when they’re feeling sensitive.
5
Cruciferous Vegetables
While considered generally healthy, high-fiber foods, particularly those containing insoluble fiber, should be avoided or limited if you’re experiencing nausea or diarrhea, says Haskell. Unlike soluble fiber, which helps absorb excess liquid to make stools more manageable, insoluble fiber doesn’t dissolve in water. Instead, it adds bulk to the stool and helps move food through the digestive tract more quickly, which can aggravate symptoms like diarrhea.
Insoluble fiber is found in cruciferous vegetables, like kale, broccoli, cauliflower, and Brussels sprouts, as well as fruits like blackberries and raspberries. Whole grains, such as brown rice and whole-grain bread, also contain significant amounts of insoluble fiber.
Janulewicz says that these high-fiber foods can be difficult to digest and may irritate the gut, particularly during a flare-up. “Cooking them makes them gentler, but some patients may still need to avoid them,” she says. Instead, opt for foods with soluble fiber, such as cooked oats and applesauce, which are generally easier on the gut and can help manage diarrhea.
6
Sugary Foods and Beverages
Sugar might taste sweet and comforting for some, but it can worsen diarrhea. Sugar may speed up digestion, meaning food moves too quickly through the gut, which can lead to loose stools and discomfort, says Haskell. When your gut is already sensitive or you’re dealing with diarrhea, it’s best to steer clear of foods high in added sugars.
Common foods that contain high amounts of added sugar include ice cream, soda, candy, baked goods, and many breakfast cereals. Check the nutrition facts label and try to limit foods that have more than 20 percent of the daily value (DV) of added sugars per serving, says Haskell.
7
Bacon, Sausage, and Other Deli Meats
Protein is an important part of your diet when managing chronic GVHD, as it helps maintain muscle mass and support healing. But choosing the right type of protein is also important.
“Processed and cured meats like bacon, sausages, hot dogs, and deli meats often contain additives and high amounts of sodium,” says Janulewicz. For example, 100 grams (g) of prepackaged deli ham meat (7 to 8 slices) contains about 1,040 milligrams (mg) of sodium. While that might not sound like much, it can add up quickly, especially since the recommended sodium intake for most adults is no more than 2,300 mg per day. If you eat several slices of deli meat and other salty foods daily, you could easily exceed that amount.
For a healthier and less irritating alternative, opt for fresh, lean proteins like skinless grilled or baked chicken breast, turkey, lean cuts of beef like sirloin, or fish like salmon or cod. Cooking meats yourself lets you avoid added preservatives and excess sodium. If you need a prepackaged option, check the labels for low-sodium choices, such as those with five percent or less sodium per serving.
8
Milk, Cheese, and Other Dairy Products
GVHD can make you more sensitive to lactose — the natural sugar in dairy products — even if you never had problems with it before, Haskell says. Foods containing lactose, such as milk, cheese, yogurt, and ice cream, can cause or worsen diarrhea and lead to bloating and other discomforts.
If you’re struggling with digestive issues or know you’re lactose intolerant, it’s best to avoid dairy. Lactose-free milk like Lactaid, plant-based alternatives like almond or oat milk, and dairy-free yogurts can be gentler options on the gut. Some people with chronic GVHD can gradually reintroduce small amounts of dairy into their diet as they heal, while others find that avoiding it altogether makes them feel better.
9
Coffee and Other Caffeinated Products
You may want to reach for a cup of coffee or an energy drink for a boost when you’re managing GVHD. But Janulewicz says that these caffeinated products should be avoided as they can lead to dehydration and worsen diarrhea. Caffeine naturally stimulates your digestive tract, which can make loose stools even more frequent.
Alternatives like decaffeinated coffee and herbal teas, such as chamomile or ginger tea, can be comforting and hydrating. If you prefer carbonated drinks, ginger ale can be easier on your stomach. If you’re used to drinking caffeine regularly, consider gradually reducing your intake rather than stopping suddenly to avoid caffeine withdrawal symptoms, such as headache, irritability, and difficulty concentrating.
The Takeaway
- If you’re managing chronic graft-versus-host disease (GVHD), avoid raw or undercooked meats and eggs and choose pasteurized dairy and juices. Opt for fresh, lean proteins over processed and cured meats.
- Consider avoiding cruciferous vegetables, sugary drinks, and spicy or acidic foods, which can irritate your gut and worsen diarrhea.
- Limit or avoid caffeine and spicy foods, and if lactose bothers you, opt for lactose-free alternatives.
- Always check with your healthcare team before making any dietary changes, and consider working with a registered dietitian.
Resources We Trust
- Mayo Clinic: Allogeneic stem cell transplant
- Cleveland Clinic: Foods to Avoid After Transplant: Post-Transplant Diet for Patients
- Food Safety: Keep Food Safe
- City of Hope Cancer Center: Emotional Impact of Chronic GVHD
- GVHD Alliance: Support & Resources