Patient Information

How to have a nourishing diet

Name: Where do I start? Foods high in calories and protein can help you Date: to increase your energy intake, without adding extra bulk to your diet. Having 3 small meals with regular snacks and nourishing fluids in between Your Dietitian: can also help you to meet your dietary needs, even if your appetite is smaller than usual.

Contact Number: How to enrich your food Milk and milk products Who is this leaflet for? „ Aim to use at least 600 mls (1 pint) of full fat Feeling unwell, or having certain medical milk daily (Calcium enriched sweetened milk treatments may mean your appetite is smaller alternatives such as Soya, Oat or Nut milks than usual. Appetite can also decrease as you can also be used). get older. Some people find that even if their „ Milk can be fortified by adding skimmed appetite is normal, the condition they have milk powder. Use 4 tablespoons per pint of means they need more nourishment than usual milk, or 3-4 teaspoons per serving added to to maintain their weight. In all these cases, it is yoghurts, porridge, bought milk , very important to meet your nutritional needs sauces and soups. Milk powder can be for good health and to prevent weight loss. This bought from any supermarket e.g Marvel or booklet gives advice on what to eat and drink if supermarket own brand. Use fortified milk you are concerned about having a poor appetite, whenever you would use ordinary milk. weight loss, or are experiencing difficulties with eating. „ Milky drinks taken between meals make a nourishing snack e.g. Ovaltine, Horlicks, drinking chocolate, milky coffee or Why is good nutrition important? milkshakes. Good nutrition means a variety of foods taken „ Include milk desserts like custards, creamy regularly and providing sufficient energy, protein, yoghurt or fromage frais after meals or as a fat, carbohydrate, vitamins, minerals, fluid and snack between meals. fibre to meet your needs. „ Condensed milk or cream is delicious used Good nutrition is essential, especially during as a dessert topping or stirred into puddings, periods of illness, as it means you will be custards and sweet sauces. stronger, better able to fight infection and cope with treatment. „ Evaporated milk can be used to replace milk in hot and cold drinks. „ Yoghurt or cream added to soups or casseroles gives additional flavour and energy.

Reference Number: RDE 20 188 002 Page 1 of 10 (version date: January 2021) „ Yoghurt, fruit juice, fruit, cream and honey „ Instead of grilling or baking, try roasting or or sugar can be added to liquids to make a frying foods in oil or butter. refreshing drink. „ Use salad cream, mayonnaise and dressings to „ Choose thick and creamy/luxury/Greek add flavour and energy to salads, vegetables, yoghurt and avoid diet or low fat varieties. jacket potatoes, sandwiches, pasta, chips or even with meat and fish. „ Use milk based sauces wherever possible; examples include cheese sauce on cauliflower, „ Fry rice, chips or roasted potatoes with oil to eggs or fish, and custard on fruit. increase the energy content.

Cheese Sugar „ Grated cheese added to , „ Use ordinary sugar instead of artificial soups, sauces or melted on vegetables/ sweeteners. Stir plenty into drinks and desserts. burgers/fish/beans adds flavour, energy and protein to dishes. „ Use on breakfast cereals and porridge or choose sugar/honey coated cereals. „ Cheese and make a good snack between meals. „ Drink ordinary squash and fizzy drinks instead of sugar free/diet varieties. Caution: „ Always use full fat varieties e.g. Cheddar, fizzy drinks may fill you up and reduce your Cheshire or full fat cheese spread. appetite further. Protein sources „ Add jam, golden syrup, lemon curd, chocolate spread, honey or treacle to milk puddings, „ Aim for three portions of protein each day. yoghurts and porridge, or spread thickly on toast. „ Choose from meat, fish,poultry, eggs, cheese, nuts, seeds, pulses (beans and lentils), (See Frequently asked Questions section if you tofu, Quorn®, soya or pea protein. It is not have diabetes). necessary to remove fat or skin from meat. These protein sources can be used in salads or Fruit and vegetables as sandwich fillings. „ This group of foods is not high in energy or „ Add minced meat/flaked fish/corned beef/ protein, but provide necessary vitamins and beans/lentils to soups and stews. minerals. Aim to eat a variety of different coloured fruit and vegetables to provide a „ Try cheese/white/parsley sauce with fish. range of nutrients. Fresh, frozen and tinned „ Omelettes, fried, scrambled or poached eggs varieties are all nutritious. They also provide can be a nourishing lighter meal. Boiled fibre to help prevent constipation. mashed egg can be added to rice or mashed „ Add extra energy to these foods to increase potato. the nourishment they provide. Fats, sauces and dressings „ Try milky sauces e.g. cheese/white sauce on vegetables. „ Avoid low fat spreads. „ Stir fry vegetables or add butter/oil after „ Use fats e.g. butter or oil as often and as cooking. generously as possible in cooking. „ Dried fruit are higher in energy and can be „ Spread butter or margarine thickly on bread, eaten as a snack or added to cereal, salads, toast and scones. cakes and desserts. „ Margarine, butter or olive oil can be added to „ Buy tinned fruit in syrup rather than natural hot vegetables and potatoes before serving. juice.

Reference Number: RDE 20 188 002 Page 2 of 10 (version date: January 2021) „ Add extra cream, chocolate sauce or custard Toast to fruit for dessert or a snack. Topped with: „ Use dressings on salads to increase their energy content. „ /pilchards in oil/sauce. „ Baked beans with cheese. „ Drink fruit smoothies made with ice cream, yoghurt or cream. „ Cheese. Soup „ Ravioli. „ Spaghetti with cheese. „ Make packet or condensed soup with milk instead of water. Use milk when making „ Eggs. home-made soup. „ Welsh Rarebit. „ Add cheese, cream, fromage frais or yoghurt „ Croque Monsieur. and stir in well, serve with bread. „ Jam, marmalade, honey, peanut butter or „ Choose thick and creamy or ‘cream of’ soups chocolate spread. rather than thin soups e.g. consommé. „ Try adding beans, pasta, rice or dumplings to Snacks soups. „ Crackers or biscuits with butter and cheese. „ Fruit cake/malt loaf with butter. Quick and nourishing snack and „ Toasted crumpets/teacakes with butter and meal ideas jam/marmalade or cheese. Keep a store of ready prepared convenience „ Soup with added cheese/cream and bread. foods and nutritious snack meals for when you „ Breakfast cereal with milk/yoghurt and sugar/ are feeling less well. honey. Sandwiches „ Ice cream/sorbet/frozen yoghurt. Fill with: „ Readymade desserts e.g. trifle, crème caramel, mousse. „ Cold meat/bacon. „ Cereal bars. „ Tinned fish. „ Small sandwiches or rolls. „ Cheese/cheese spread. „ Crisps or chips with dips e.g hummus, „ Peanut butter. , soured cream, cream cheese or guacamole. „ Patè. „ Packets of nuts try yoghurt or chocolate „ Hummus. coated varieties, dried fruit or seeds. „ /chicken/egg/ mayonnaise. , chocolate and crisps „ Smoked/flaked salmon with cream cheese. „ These provide extra energy when taken with Try using different types of bread and rolls for meals. Take care that they don’t spoil your variety e.g. bagels, pitta bread, breakfast muffins, appetite for more nourishing foods. and add sauces, mayonnaise and relish for extra „ Try sweet pastries such as cakes, biscuits, flavour and energy. custard tarts, Danish pastries, doughnuts, éclairs, iced buns and cupcakes for between- meal snacks.

Reference Number: RDE 20 188 002 Page 3 of 10 (version date: January 2021) „ Savoury items to try include mini pies, scotch Easy puddings eggs, savoury slices, sausage rolls, spring rolls and . „ Tinned rice /custard. „ Chocolate, sweets and crisps are ideal snacks „ or sponge pudding if you are on the go. with cream. „ Pancakes with syrup/honey, sugar and lemon Simple meals or chocolate spread. „ Shepherd’s or Fisherman’s pie with added „ Thick and creamy yoghurt, Greek yoghurt or cheese in the topping. high protein yoghurt. „ Corned Beef Hash with carrots. „ Trifle. „ Lasagne with salad, topped with a dressing „ Tinned fruit in syrup with ice-cream/sorbet. and served with oven chips or garlic bread. „ Mousse/fruit fool. „ Sausages and baked beans with cheesy mashed potato. „ Pre-prepared chocolate/flavoured puddings „ Egg and bacon on toast with butter. e.g. Mars, Aero, Caramel (examples of brand names available). „ Boil-in-the-bag fish with rice or potatoes and frozen vegetables. „ Crème caramel. „ Tinned stew and instant potato with frozen „ /junket/instant whip. vegetables. „ Milk jelly. „ Tinned macaroni cheese with tomatoes. „ Sago/semolina/tapioca with jam. „ Savoury rice with cold meat/fish and mixed „ . vegetables. „ Cheese cake and cream. „ Omelette with cheese/meat served with fried mushrooms. „ Éclairs/profiteroles. „ Oven ready fish/fish fingers and oven chips „ Fruit pie or crumble with ice cream/custard. and peas. „ Pizza. Nourishing drinks „ Egg fried rice with cold meat/fish or tofu. Add hot milk, ideally fortified with milk powder, to: „ Creamy/coconut based curry with rice. „ Malted drinks e.g Horlicks, Ovaltine. „ Gammon and egg with chips and peas. „ Cocoa or drinking chocolate. „ Chicken or mini kievs with potato wedges and peas. „ Coffee. „ Risotto with cheese and cream. „ Instant soup. „ Jacket potato with baked beans and cheese. Hot milky drinks are comforting and warming. Have a flask by your side so that you can have a If cooking is tiring, use convenience foods. hot drink frequently. Supermarkets have a good range of frozen, chilled, tinned or packet ready meals. There are Add cold milk to: companies who will deliver frozen meals to your „ Milkshake flavourings e.g Crusha, Nesquik. door. Ask your dietitian for further details. Milk delivery services may also deliver other items on „ Mashed fruit with cream / yogurt / ice cream request e.g. potatoes/juice/yoghurt. to make milkshakes.

Reference Number: RDE 20 188 002 Page 4 of 10 (version date: January 2021) Other ideas include: Sample meal plans „ Fruit or vegetable juice. „ Soft/fizzy drinks (not diet or sugar free Breakfast varieties) with added cordial and ice cream to Fruit Juice make an ice cream soda. Porridge with cream and honey „ Fruit smoothies made with ice cream, cream or yoghurt. Cup of tea/coffee „ Readymade milk drinks e.g. Mars, Galaxy, Bounty or supermarket own brands. Mid morning Cup of milky coffee/latte „ Readymade yoghurt drinks e.g. Yop, Yazoo, Frijj. Biscuits Food supplements Lunch There are commercial products available at Egg Mayonnaise sandwich chemists which can be taken between meals to with a packet of crisps supplement your diet. Occasionally, these can be taken as a meal replacement if you are unable to Fruit and ice-cream eat your normal meals. Cup of tea/coffee „ Complan Food Ltd COMPLAN® „ Nestlé Meretine Energis® Mid afternoon These are all available in a variety of sweet and Cup of tea/coffee savoury flavours. Try a variety to find one you enjoy. Complan is also available on prescription. Carrot cake

Ice-cream, yoghurt or liquidised fruit can Evening meal be added to the sweet varieties to provide alternative flavours. The natural or unflavoured Cheese omelette with mushrooms varieties may be added to puddings, sauces, drinks and soups. Salad with dressing Other products are available only on prescription Thick and creamy yoghurt – your Dietitian will advise you if these are necessary. Evening Snack Important: If your appetite is poor and you Hot Chocolate continue to eat very little and/or you are losing weight, please consult your Dietitian Nuts and raisins for further advice. Contact details are on the front of this booklet.

Reference Number: RDE 20 188 002 Page 5 of 10 (version date: January 2021) Breakfast Shopping list ideas Cup of tea/coffee Savoury snacks Fried bacon „ Patè „ Sausage roll Breakfast muffin with butter „ Mid morning „ Scotch egg „ Milkshake „ Spring rolls Cereal bar „ Onion bhaji Lunch „ Cheese straws „ Cheese biscuits Cream of chicken soup with bread and cheese „ Nuts Milk jelly „ Dried fruit „ Garlic bread Cup of tea/coffee „ Crisps Mid afternoon „ Bombay mix Custard tart „ Prawn crackers „ Cheesy/creamy dips Cup of coffee „ Chicken drumsticks Evening meal „ Chicken satay sticks Fish in white sauce „ Taramasalata „ Guacamole Mashed potato + Broccoli „ Tapenade Banana custard Cup of tea/coffee Sandwich fillings „ Corned beef Evening snack „ Ham Crumpets with butter and „ Tinned fish – salmon, tuna, sardines, jam/peanut butter pilchards, crab Malted drink „ Egg/tuna/chicken/prawn mayonnaise „ Cream cheese „ Peanut butter „ Bacon „ Sausage including vegetarian varieties „ Cheese „ Falafel „ Hummus

Reference Number: RDE 20 188 002 Page 6 of 10 (version date: January 2021) For quick and easy meals Puddings „ Eggs „ „ Baked beans „ Junket „ „ Crème brulee/caramel „ Cheese „ Sticky toffee/ „ Baking potatoes „ Jam/chocolate sponge „ Canned creamy soup „ Fruit pies/crumble „ Sausages „ Custard „ Bacon „ Cheesecake „ Gammon steak „ Sundae „ Lamb cutlets „ Mousse/instant whip „ Pork chop „ Greek yoghurt „ Pasta with a cheese sauce „ Thick and creamy yoghurts

Ready made meals PASTRIES „ Toad in the hole „ Eclairs „ „ Doughnuts „ Chicken pie „ Fruit or sponge cake „ Cheese and vegetable pie „ Chocolate brownies „ Roast dinner „ Caramel slices „ Shepherd’s pie „ Turnovers/Jam tarts „ Fish pie „ Danish pastries „ Chicken kiev „ Tea cake/scone „ Curry „ Crumpets/muffins „ Battered/breaded fish or „ Croissant „ Quiches „ Brioche „ Macaroni cheese „ Lasagne Biscuits „ Pizza „ Flapjack „ Meat casserole with dumplings „ Chocolate digestives „ or bought takeaways „ Oat biscuits „ Shortbread/cookies „ Bourbons „ Custard Creams „ Jammy Dodgers „ Cereal bars

Reference Number: RDE 20 188 002 Page 7 of 10 (version date: January 2021) Sweets Frequently asked questions „ Chocolate and chocolate bars Q: I’ve always wanted to lose some „ Fudge weight. Surely it’s better to be „ Toffee thinner? „ Chocolate/yoghurt coated dried fruit or nuts A: Losing weight during illness reduces your ability to fight infection, delays healing, „ Boiled sweets reduces mobility and can lead to feeling low in mood. Preventing weight loss is a Other very important part of your treatment, and „ Whole milk improves your likelihood of recovery. „ Skimmed milk powder Q: This leaflet recommends lots of fatty „ Evaporated/condensed milk and sugary foods, I thought these „ Butter/margarine were unhealthy! Should I really be „ Olive or vegetable oil eating them? A: It is important for people with a small „ Cream appetite to eat a diet which provides all the „ Tinned/packet/pot custard or custard powder nutrients you need (not only vitamins and minerals, but energy and protein too). If you „ Malted drinks have a small appetite, you are unlikely to „ Hot chocolate meet your energy and protein needs if you follow a low fat, high fibre diet. Instead, you „ Milkshakes need to eat a diet rich in fat and sugar which is higher in energy to try and prevent weight „ Fruit juice loss. „ Tinned fruit in syrup „ Over the counter supplement drinks Q: I’ve got diabetes, is this advice still appropriate for me? Freezer cabinet A: The best way to prevent weight loss if you „ Frozen vegetables are diabetic is to add extra fat to your diet, rather than sugar. This will ensure you „ Frozen chips receive extra nourishment without causing „ Yorkshire puddings poor blood sugar control. Much of the advice in this booklet will be appropriate for you. „ Meat and fish or vegetarian alternatives However, take care with the sweet products recommended, as these may cause your „ Frozen ready meals blood sugar to rise. Talk to your dietitian for „ Pizza personal advice. „ Ice cream „ Frozen desserts „ Garlic Bread „ Naan bread

Reference Number: RDE 20 188 002 Page 8 of 10 (version date: January 2021) Q: I don’t like milk, do I need to start A guide to symptom control drinking it? Useful tips to help with some symptoms you may A: If you don’t like the taste of milk, try adding be having because of your illness or medication. milkshake powder, pureed fruit, or syrup to change the taste. Or you could add milk to Loss of appetite soups and sauces for a savoury flavour. You „ Eat little and often – have nourishing snacks could also increase your intake of cheese, or drinks between meals. yoghurt, cream and custards instead to boost your diet. Dairy free alternatives are available „ Drinking after meals rather than before may but many of these products are lower in help if you feel full easily. Try milky drinks, energy than their dairy counterparts. Talk to soups and fruit juice which have more your dietitian if this applies to you. nourishment than tea, coffee, squash and water. Q: I’m vegetarian, is that ok? „ Make food look attractive to tempt your A: If you don’t eat meat or fish, you will still be appetite and keep portions on your plate to able to boost the calories in your diet. Include small, realistic quantities. vegetarian sources of protein at every meal „ Make sure you are relaxed before meals and – try eggs, pulses, nuts, soya products and comfortable when you are eating. Take your dairy products (milk, cheese, yoghurt, cream). time and chew your food well. Remember that fruit and vegetables are lower in calories than other foods. Try adding „ If you are tired, avoid foods that are bulky extra sauces or cheese onto vegetables, and and need a lot of chewing. serving fruit with sugar and cream, yoghurt, custard, or ice-cream. „ Try to think of foods that you will enjoy eating – your favourite foods! Q: I don’t like all the foods that you’ve „ Prepare food in advance when you feel well suggested, do I have to eat them enough to cook. When your appetite is good, anyway? make the most of it. It is a good idea to keep snacks handy. A: When you are eating smaller amounts than „ Try a small glass of sherry or brandy half an usual, it is important that you enjoy the foods hour before a meal to increase your appetite that you eat. This booklet gives a variety of (check with your doctor first). suggestions to account for different tastes. If you dislike a particular food or drink „ If you are unable to manage a full meal, suggested, try to choose another food that have a supplemented soup and pudding or a you prefer from the list. nourishing drink e.g. Meritene, Complan or prescribed supplement drink instead. Q: Are there any foods that I need to „ Choose full fat foods wherever possible – avoid? these may be called ‘luxury’ or ‘thick and A: Unless you have been told specifically by your creamy’ rather than ‘light’, ‘diet’ or ‘low fat’ dietitian or doctor that you should avoid a „ Big plates of food can be off-putting. A particular food or drink, there is no need smaller plate can seem more manageable, for you to restrict your diet. You can eat and you can always have another helping if whatever you like. you still feel hungry. „ Some exercise, activity or fresh air can help improve appetite.

Reference Number: RDE 20 188 002 Page 9 of 10 (version date: January 2021) Nausea and vomiting Diarrhoea „ Try not to get anxious about eating – aim „ Drink plenty of fluids to replace water loss. to take as much nourishment as possible at whatever time of day suits you best. „ It may be helpful to cut down on highly spiced, greasy or fried foods. „ If cooking smells put you off your food, avoid cooking. Ask family and friends to prepare „ Take small frequent meals throughout the meals if possible. Keep your kitchen well day. ventilated to reduce cooking smells Cold food „ When the diarrhoea has stopped, slowly start and drinks have fewer smells and may be eating the foods you have been avoiding. more suitable. You may be given additional advice regarding „ Take small, frequent meals and try to build up reducing fibre intake. Discuss with your Dietitian. the amount you can manage. „ Dry foods e.g. toast, crackers and plain Constipation biscuits may be easier to take. „ Eating higher fibre foods can help. Try „ Cool, fizzy drinks sipped between meals may wholemeal bread and biscuits, higher fibre relieve nausea – avoid taking with meals as cereals e.g. branflakes or Weetabix. Fruit, they may fill you up. vegetables and pulses are also excellent sources of fibre. „ Greasy, fatty foods and fried foods are all likely to worsen nausea. „ If you feel full quickly when eating higher fibre foods instead try drinking fruit or „ If you are able, try to go for a walk in the vegetable juice between meals and having fresh air before your meal and eat in a well soft tinned or stewed fruits as a pudding. ventilated room. „ Fibre helps constipation by absorbing fluid – „ Tight clothing and lying down after meals will make sure you drink at last 6-8 cups of fluid cause discomfort. per day. „ Your doctor may be able to prescribe anti- Your doctor may be able to prescribe medication nausea medication. to help if changing your diet makes no difference.

Written information cannot replace personalised recommendations. For further advice please seek a dietetic referral from your consultant or GP.

The Trust cannot accept any responsibility for the accuracy of the information given if the leaflet is not used by RD&E staff undertaking procedures at the RD&E hospitals. © Royal Devon and Exeter NHS Foundation Trust Designed by Graphics (Print & Design), RD&E

Reference Number: RDE 20 188 002 Page 10 of 10 (version date: January 2021)