Graft-versus-host disease (GVHD) happens after a stem cell transplant when donor cells attack the recipient’s cells. This reaction occurs because the donor cells see the recipient’s cells as foreign. More than 60 percent of people with GVHD also have problems in their stomach and intestines, a condition known as gastrointestinal (GI) GVHD. If your GI tract is involved, you may have symptoms like nausea (with or without vomiting), diarrhea, and cramping. To help manage these symptoms, a doctor may refer you to a registered dietitian and recommend following a GVHD-friendly diet.

The GVHD diet includes easy-to-digest foods that allow your digestive system to heal and may prevent complications. As your symptoms improve and your body heals, you can slowly add more foods and drinks back into your diet. Here’s a look at how the GVHD diet can support your recovery, plus which foods to eat and avoid.

How GVHD Affects Digestion

Though GVHD can affect any part of the digestive system, it most commonly involves the end of the ileum (the last section of the small intestine), the ascending colon, and the cecum (parts of the large intestine). In some people, the stomach and rectum may be affected as well.

In gastrointestinal GVHD, the immune system mistakenly attacks the lining of the intestines (epithelial tissue). This damages the gut’s protective barrier, making it harder for your body to digest food and absorb nutrients. As a result, malabsorption (difficulty absorbing nutrients) can occur, leading to weight loss and other digestive issues.

How the GVHD Diet Works

When GVHD causes inflammation in the GI tract, it disrupts digestion and makes it harder for your body to absorb nutrients. The GVHD diet is designed to help your gut heal by gradually reintroducing foods in five phases starting with the easiest-to-digest options and slowly expanding your diet as your body recovers.

• Phase 1 (bowel rest) — This phase is for people with severe diarrhea. During this time, you won’t eat or drink anything to give your digestive system a chance to heal. If needed, doctors can provide intravenous (IV) nutrition, which delivers essential nutrients directly into your bloodstream through a small tube in a vein.
• Phase 2 (liquid diet) — Once you’re ready, you’ll begin drinking easy-to-digest liquids like electrolyte drinks, popsicles, and broths. These should be low in fiber, acid, lactose, fat, and caffeine to prevent irritation.
• Phase 3 (soft, low-fiber foods) — If you tolerate liquids well, you’ll start eating bland, low-fiber, low-fat, and low-acid solid foods that are gentle on your gut.
• Phase 4 (gradual expansion) — You’ll slowly add more food groups back into your diet, paying attention to how your body responds.
• Phase 5 (regular diet): Once your digestive system has healed, you can return to a balanced, regular diet, while still avoiding any foods that trigger symptoms.

5 Foods To Eat on the GVHD Diet

As you move into phase 3 or phase 4 of the GVHD diet, it’s important to eat high-protein, high-energy foods that are low in fiber. This helps prevent weight loss and supports your body’s recovery. Because large meals may be difficult to tolerate, try eating frequent meals of small amounts of food every few hours.

1. Plain White Bread and Other Low-Fiber Grains

While on a GVHD diet, it’s important to limit fiber until your digestion is back to normal. Plain white bread and other low-fiber grain products are easier for your body to digest and can help prevent irritation.

Plain breads recommended during phase 3 of the GVHD diet, include:

• White bread
• Plain bagels
• English muffins
• Crumpets

Some low-fiber cereals — both hot and cold — are also well tolerated, such as. These include plain Cheerios, Rice Krispies, Rice Chex, corn flakes, cream of wheat, and cream of rice.

Other recommended foods made from low-fiber grains include pasta, noodles, white rice, crackers, and tortillas.

2. Low-Fiber, Low-Acid Fruits

During phase 4 of the GVHD diet, you can start eating fruits that are easy to digest, low in fiber and acid. These fruits provide important nutrients while being gentle on your digestive system.

Recommend easy-to-digest fruits include:

• Bananas
• Canned peaches, pears, cherries, and fruit cocktail (drained, without pineapple)
• Seedless melons

You can also enjoy applesauce and no-pulp fruit juice (avoid prune, tomato, and citrus juices).

3. Cooked Vegetables

During phase 4 of the GVHD diet, you can begin eating a wider variety of foods, including those with slightly higher amounts of fat, fiber, and lactose (the natural sugar in dairy products). At this stage, cooked vegetables are usually easier to digest and can provide important nutrients without irritating your gut.

Recommended GVHD-friendly cooked vegetables include:

• Potatoes, sweet potatoes, or yams (peeled)
• Beets
• Carrots
• Green beans
• Mushrooms
• Pumpkin and other squashes
• Asparagus (tips only)

While some vegetables may be gentle enough to eat raw, it’s best to cook them until tender at this stage to make digestion easier.

4. Lean Proteins

During phase 4 of the GVHD diet, you can start incorporating lean, easy-to-digest protein sources. Protein is essential for healing and maintaining strength, so it’s important to include options that fit your dietary preferences and needs.

Recommended GVHD-friendly protein sources include:

• Chicken (skinless, baked or grilled)
• Fish (grilled, baked, or poached), including canned tuna (packed in water)
• Lean ham
• Eggs (well-cooked: hard-boiled, scrambled, or plain omelet)
• Turkey bacon or turkey burgers
• Low-fat luncheon meats or hot dogs
• Cooked tofu

You can prepare fish grilled, baked, or poached, while eggs should be either hard-boiled, scrambled, or made into a plain omelet. You can also try creating a casserole by combining any of the above ingredients.

5. Lactose-Free Dairy Products

Many dairy products contain lactose, a natural sugar that may be hard to digest while your body recovers from GVHD. It might take time before you can tolerate regular dairy, but during phase 4, you can slowly start reintroducing lactose-free or alternative dairy options.

Recommended GVHD-friendly dairy options include:

• Lactose-free milk (such as Lactaid milk)
• Soy milk (higher in protein than almond or oat milk)
• Lactose-free cheese and yogurt (plain, low-fat versions are best)

If you’d like to try regular dairy, you may be able to tolerate low-fat cheese or yogurt by taking a lactase enzyme supplement (such as Lactaid Fast Act) to help with digestion. However, talk to your doctor before using any supplements. Some people find they can tolerate small amounts of low-fat, plain dairy products even without Lactaid.

4 Foods To Avoid on the GVHD Diet

While some foods can help your gut heal, others may be too difficult to digest and worsen symptoms. Avoiding certain foods — especially those high in fiber, acidity, and fat — can help reduce irritation and support recovery. Here are some foods to steer clear of while following the GVHD diet.

1. Whole Grain Bread and Other High-Fiber Grains

Because fiber can be hard to digest during GVHD recovery, it’s best to avoid breads and grains that are high in fiber. These foods can irritate your digestive tract and make it harder for your body to absorb nutrients.

Breads and grains to avoid include:

• Whole grain or rye breads
• Breads, cereals, or grains containing more than 2 grams of fiber per serving of fiber
• Oats (rolled or raw)
• Cereals, breads, or grains containing seeds, nuts, or dried fruit

Other high-fiber grains to avoid while on the GVHD diet, include:

• Brown rice
• Corn
• Whole grain pasta, or any pasta made with high-fiber flour
• Muesli bars
• Wheat germ
• Cakes or biscuits made using high-fiber flour or with added seeds, nuts, coconut, or dried fruit

2. Fried Foods

Fried foods are high in fat and hard to digest, which can worsen inflammation and gut irritation while recovering from GVHD. Instead, it’s best to choose lean, easily digestible proteins that support healing.

Fried foods to avoid on the GVHD diet, include:

• Fried meats
• Fried chicken
• Fried fish
• Fried eggs
• Fried deli meats

Many of these proteins are not off-limits on the GVHD diet — fish, eggs, and lean meats are encouraged. However, when fried, the added fat makes them harder to digest and less suitable for those recovering from GVHD.

In addition, you should also refrain from eating any fried snack foods. Some processed snack foods to avoid, include:

• French fries and fried potatoes
• Potato chips
• Corn or tortilla chips
• Popcorn
• Fried nuts
• Fried pickles
• Fried garlic

3. Raw Fruits and Vegetables

Most raw fruits and vegetables are not recommended for people recovering from GVHD because they can be hard to digest and irritate the gut. Cooking softens fiber and reduces acidity, making vegetables easier on the digestive system — which is why cooked vegetables are encouraged on the GVHD diet.

When eaten raw, many fruits and vegetables contain too much fiber or acid, which can worsen symptoms. The only raw fruits recommended during food reintroduction are bananas and ripe melon.

All other fruits and vegetables should be cooked until tender before eating to support digestion and reduce irritation.

4. Spicy or Acidic Foods

Spicy and acidic foods can irritate the digestive tract, which is already inflamed from GVHD. To avoid worsening symptoms, it’s best to steer clear of heavily seasoned or acidic foods, including tomato-based dishes and citrus fruits.

In addition, spicy and acidic condiments should also be avoided. These include:

• Chili powder
• Ketchup
• Pepper
• Vinegar
• Cinnamon
• Hot sauces

Talk to Your Doctor

If you have gastrointestinal GVHD, it’s important to talk to your doctor or dietitian about the best foods to eat and whether your treatment plan is working for you. A registered dietitian can help you navigate the different phases of the GVHD diet and ensure you’re getting the nutrients you need.

While following the GVHD diet, let your healthcare team know about any symptoms or changes you notice. Only move to the next phase of the diet if your symptoms are steadily improving.

Find Your Team

On myGVHDteam, the site for people with graft-versus-host disease and their loved ones, people come together to ask questions, give advice, and share their stories with others who understand life with the condition.

Do you have GVHD that affects your digestive system? What has been your experience following the GVHD diet? Share your experience in the comments below.