n The Leeds Teaching Hospitals NHS Trust Department of Nutrition and Dietetics Fortifying Your Diet A guide to eating well with chronic kidney disease Information for patients It has been recommended that you follow a high energy (calorie) diet to help improve your nutritional intake and prevent weight loss. This booklet has been designed to help you do this and includes some meal and snack suggestions. Why is it important to eat well? • To prevent weight loss • To maintain muscle mass • To ensure an adequate dietary intake of vitamins and minerals • To help fight infection • To improve wound healing Why could I be losing weight? There are several reasons why you may be losing weight. Ask yourself the following questions to help find out why: • Are you missing meals? • Have you lost interest in food? • Do you feel that you are eating a limited range of foods? • Are your portion sizes smaller? • Are you leaving food on your plate? • Do you regularly feel sick? • Do you have problems with constipation or diarrhoea? 2 What can I do to help improve my dietary intake? • Try to eat little and often by having three small meals plus a snack between meals • Wait until after a meal to have a drink to prevent you from feeling too full whilst eating • Ask for help with meal preparation • Make meals in bulk and freeze individual portions • You may be entitled to have “meals on wheels” or you can get frozen meals delivered; ask to speak to the renal dietitian or social worker • Contact your dentist if you have dental problems, or dentures which do not fit properly • If you are experiencing constipation or diarrhoea or suffering from nausea, speak to your GP or renal doctor as medication could be prescribed to help What foods should I eat to help prevent weight loss? To help you maintain or gain weight you will need to increase your energy intake. Carbohydrates (sugars and starches) and fat are the main sources of energy in our diet. It is also important to continue to eat adequate protein foods e.g. meat, chicken, fish or pulses. 3 Can I have ready meals? It is usually advisable to keep ready meals to a minimum due to their high salt content, although they can be useful if you have a small appetite or have difficulty preparing meals. Ready meals are available from the fridge and freezer departments of supermarkets and local food shops. They can be heated up in the oven or microwave. Many varieties of meals are available including shepherds pie, roast beef and Yorkshire pudding, curry with rice, fish pie or lasagne. Speak to the renal dietitian or social worker who have information on companies who produce similar meals and deliver to your home. What if I have been previously advised on a low potassium or low phosphate diet? The levels of potassium and phosphate in your blood can fall when you are not eating as well as usual. For this reason previous dietary restrictions may be relaxed during this time. The dietitian will continue to monitor your bloods and will inform you if you need to relax any dietary restrictions. 4 How to fortify foods you eat each day Ordinary foods can be fortified, increasing their energy content, without increasing the amount you need to eat. • Use full fat dairy products e.g. blue, silver top or Jersey milk (remember to include as fluid if you have a fluid allowance), cream cheese or milk puddings and thick and creamy yoghurts • Spread butter or margarine thickly on toast and bread • Add plenty of butter or margarine to potatoes and vegetables • Use olive oil or vegetable oil liberally in cooking and on salads and bread • Use full fat mayonnaise and salad dressings • Avoid low-fat or ‘light’ products • Add double cream to sauces, cakes, puddings and desserts • Double cream can be added to full cream milk to make it higher in energy • Use sugar liberally, adding it to cereals, drinks and puddings • Use honey, jam, lemon curd, syrup and marmalade freely • Use full sugar fizzy drinks but keep to between mealtimes as they can cause fullness 5 Quick and nourishing savoury snack foods Snack meals • Omelette, scrambled, boiled or poached egg with bread and butter • Boil in the bag fish with mashed potatoes (add cream and/or butter) • Oven baked fish or fish fingers served as a hot sandwich • Macaroni cheese • Cauliflower cheese with bread or potatoes • * Jacket potato with topping e.g. cheese, tuna mayonnaise, * baked beans • Pasta salad e.g. pasta mixed with tuna mayonnaise and sweetcorn • Corned beef hash • Sausage roll, Cornish pasty, meat or chicken pie • Sausages with bread or tinned potatoes • * Samosa, pakora or bhajis Sandwiches • Ham and mustard, beef and horseradish, cheese and pickle, tuna mayonnaise, salmon mixed with mayonnaise and cucumber, coronation chicken, prawn mayonnaise, egg mayonnaise with cress • Try using different breads such as granary, pitta, bagels, naan bread, soft rolls or flour tortilla wraps Toast • With mackerel or pilchards, cheese, * baked beans, tinned spaghetti, egg, cream cheese, hummus or tuna mayonnaise * These foods are high in potassium. The dietitian will inform you if they need to be limited. 6 Quick and nourishing desserts • Pavlova • Sponge pudding e.g. jam or syrup • * Apple upside-down pudding • * Fruit pie e.g. apple, pear or raspberry • * Crumble e.g. apple, plum or peach • Lemon meringue pie • * Tinned fruit and double cream • Jelly and double cream • * Tinned fruit and jelly • Rice pudding or custard (150 g pot) • * Kulfi • * Kheer • Trifle • Ice cream • Yoghurt • Fromage Frais Some of the above can be served with cream or custard to make them higher in energy. Discuss with your dietitian how often you can have milk-based desserts. * These foods are high in potassium. The dietitian will inform you if they need to be limited. 7 Quick and nourishing between-meal snacks Bread and baked goods • Plain bread sticks • Chapati or puri • Crumpet • Teacake • Scotch pancakes • Pikelets • English muffin • Bagel • Croissant • Hot cross bun • Fruit, cherry, plain or cheese scone • Flapjack Many of the above can be eaten with: • Butter or margarine • Jam, marmalade or lemon curd • Golden syrup or honey • Cream cheese • Hummus, sour cream or mayonnaise dips 8 Quick and nourishing between-meal snacks Cakes and pastries • Fairy cake - plain or iced • Angel cake • Sponge cake with jam and buttercream or fresh cream • Battenberg cake • Madeira cake • Swiss roll or chocolate mini roll • Lemon drizzle cake • Lemon slice • Viennese whirl • Marshmallow crispie cake • Doughnut • Iced finger • Meringue • Jam tart • Treacle tart • Cream horn • * Danish pastry • Egg custard • Custard slice • Chocolate éclair • * Fruit tart • * Individual fruit pie e.g. apple * These foods are high in potassium. The dietitian will inform you if they need to be limited. 9 Quick and nourishing between-meal snacks Biscuits and crackers • Plain e.g. digestive, Rich Tea, Morning Coffee, Nice and ginger biscuits • Cream filled biscuits e.g. custard cream, Crunch Creams or Bourbons • Iced biscuits e.g. party rings and iced gems • Jam filled biscuits • Wafer biscuits • Shortbread • Cream crackers, Cornish wafers or water biscuits (with butter or margarine, jam or cream cheese) Chocolate One of the following chocolate items may be eaten each day: • Two finger Kit Kat • Milky bar (25 g) • Single finger Twix • Blue Riband • Two chocolate coated digestives • Two Jaffa cakes • Fun size chocolate bar e.g. Milky Way or Mars bar Sweets • Boiled sweets • Wine gums • Fruit chews or sour chews • Jelly Babies • Starburst • Skittles • Mints 10 Quick and nourishing between-meal snacks Sweets • Marshmallows • Pastilles What happens if I am following the advice and still losing weight? If you are still losing weight or struggling to improve your dietary intake, the dietitian may recommend that you try nutritional supplement drinks and products. There are a wide variety of products available: • Milk based drinks • Juice based drinks • Yoghurt drinks • High protein puddings • High energy liquids and powders The dietitian can arrange for you to obtain the most appropriate products on prescription from your GP. Recipes are also available from your dietitian to help you incorporate them within your diet. If you would like to purchase nutritional products over the counter e.g. Build-up or Complan, contact the dietitian to discuss those which are most suitable. 11 Personal Notes ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ..............................................................................................................