Eating well. with a small appetite. Resource 2 Information for Patients

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1 Information Prescriptions Information Prescriptions are a quick and easy way to provide information about your condition and local services. Free Prescriptions All cancer patients undergoing treatment for cancer, the effects of cancer or the effects of cancer treatment can apply for an exemption certificate for a free prescription from their GP. How can I help reduce healthcare associated infections? Infection control is important to the well-being of our patients and for that reason we have infection control procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections. We ask that you, and anyone visiting you, use the hand rub (special gel) available at the main entrance of the hospital and at the entrance to every ward before coming in to and after leaving the ward or hospital. In some situations hands may need to be washed at the sink using soap and water rather than using the hand rub. Staff will let you know if this is the case. If you require an interpreter or need a document in another language, large print, Braille or audio version please ask for assistance. Eating well with a small appetite Resource 2 Information for Patients This booklet is designed to give help and advice on eating well for people with a small appetite Issued by: Contact details: Date: Author: Sophie Hamilton Issue date: May 2010 Reviewed: January 2016 Review date: January 2018 Leaflet code: CISS - 25 Version: 5

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3 Notes recommended by your Dietitian/Nurse/Doctor: Contents Page Introduction 2 Fortifying Foods 3 Meal and snack ideas 5 Nourishing Drinks 6 Helpful hints if your appetite is poor 9 Energy saving ideas

4 Introduction This booklet is designed to give you advice if your appetite is poor and you are not eating as well as normal or if you require high energy foods to help prevent weight loss or maintain your energy levels. It is important to eat as well as you can even when you are doing less. The aim is for you to: Try to enjoy your food. Eat regular meals and snacks (eg three small meals and snacks in between). Add extra energy and protein to foods (see page 3). Try to have a variety of foods so that you don t miss out on essential nutrients including vitamins and minerals. Avoid using low fat, low calorie or diet food and drinks. Listening to your body When we perform everyday tasks, we tend to be in automatic mode, but this is not very useful to those who have high levels of fatigue and tiredness. To pace yourself and plan ahead, you can learn to hear what your body is telling you before, during and after activities. For example: Try looking closely at one particular task (shaving, dressing, bathing etc): At what point does the feeling of significant tiredness begin? Are there natural breaks in the task? Could you sit down to do the activity? Is there someone who could help you? (Talk to your GP, District nurse or Social worker). For expert advice and assessment related to pacing and equipment, request referral to an Occupational Therapist. Opt for the high calorie versions (see page 4). Try nourishing drinks (see pages 6-7). You may also need to look at reducing the amount of energy that you are using by trying some energy saving ideas (see pages 10 and 11). 2 11

5 Energy saving ideas This advice is aimed at individuals experiencing tiredness/ fatigue that makes daily activities difficult. Planning ahead, pacing and listening to your body may help to offset this fatigue and may help to manage weight loss. Planning ahead Try to identify tasks which cause extreme tiredness. Ask others (family, friends, neighbours) to help with daily activities. Plan your day so that you have time to rest and do the things you want to do. Spread tasks out over the week. Use equipment to help save energy (for instance sitting or perching instead of standing). Organise tools and materials in the work area (kitchen etc). Store items within easy reach. Pacing activities Many activities do not need to be done quickly or all in one go. The aim of successful pacing of activities is to avoid exhaustion. Try taking things more slowly. Take planned breaks before you become tired. Save some tasks for later in the day or even the next day. It is easier to keep some small reserves for the next task than it is to build those reserves after they are depleted (exhaustion). Fortifying foods If your appetite is poor and you are not eating as well as normal, the following tips may help you to get more calories (energy) without necessarily having to eat more food. You can fortify foods in the following ways:- Full fat milk: add 4 tablespoons of milk powder eg Marvel, Five. This milk can be used in the usual way; in drinks, on cereals, in sauces and puddings Savoury foods: to soups add cream, grated cheese, milk powder, evaporated milk, puréed beans or lentils, ground nuts, croutons. Try making cuppa soup with fortified full fat milk to sauces add butter or margarine (not low fat), evaporated milk, cream, full fat natural yoghurt, grated cheese, ground nuts to creamed potato add cream, butter or margarine or olive oil, grated cheese, full fat mayonnaise or salad cream, ground nuts, milk based sauces to vegetables add butter, margarine or olive oil, grated cheese, full fat natural yoghurt, full fat mayonnaise. 10 3

6 Fortifying foods Sweeter foods: to puddings ie sponge, crumble, pies add sugar, glucose, honey, syrup, seedless jam, full fat yoghurt, cream, evaporated milk, butter or margarine (not low fat), custard, ice-cream, sorbets, ground nuts to milky drinks add ice-cream, milk powder, cream, evaporated milk to breakfast cereals or porridge use fortified milk, evaporated milk, full fat yoghurt, cream, sugar, glucose, honey, golden syrup, puréed fruit or ground almonds on toast, crumpets, toasted tea cakes, muffins etc use lots of butter or full fat margarine, chocolate spread, lemon curd, cream cheese, jam or marmalade or peanut butter. Helpful hints if your appetite is poor: Make the most of the times when you do feel hungry, keep snacks handy to nibble on, such as crisps, nuts, biscuits, dried fruit. Have small frequent meals and snacks every 2 3 hours during the day rather than trying to eat three meals. Let someone else do the cooking if you can. The smell may affect your appetite. If you prepare food yourself, use foods that are easy to prepare. Avoid filling yourself up on too much fluid before a meal. Take a short walk outside, fresh air may help to stimulate your appetite. Eat meals slowly, chew the food well and relax for a while after each meal. If cooking is difficult try ready prepared meals either from the supermarket or delivered to your home eg Wiltshire Farm Foods ( ) or Oakhouse Foods ( ). Meals on Wheels may also be available in your area. Discuss with your GP practice or local council. Alcohol - a small glass of wine, beer, sherry or your favourite drink taken half an hour before a meal may stimulate your appetite. Check with your Doctor first. 4 9

7 Juice-Based Drinks Pour 2 x (5g) sachets of egg white powder (found in the home baking section of most supermarkets) into a glass. Add 40ml undiluted high juice squash or cordial to the white powder. Mix immediately and carefully (do not whisk) then gradually add 180ml fruit juice. Juice drink flavour combination ideas; high juice blackcurrant squash and cranberry high juice orange squash and pineapple juice elderflower cordial and apple juice high juice cranberry squash and orange juice Supplement Drinks Powdered drinks eg Complan, Meritene and Aymes Retail are available from most chemists and supermarkets. They are available in a range of sweet and savoury and neutral flavours. There are also some ready made versions eg Complan Smoothie, Nurishment, Nurishment Extra. If your food intake and weight has not improved within four weeks and you continue to lose weight, ask your nurse or doctor to be referred to a Dietitian or contact your GP who may be able to advise you on prescribable nutritional supplements. Meal ideas Breakfast - cereal with fortified milk, bread, toast or croissant with butter. Egg/beans on toast. Light Meals - fortified soup with bread and butter, toast with beans, cheese, egg, ravioli or tinned spaghetti. Sandwich with meat, cheese, fish or egg. Jacket potato with cheese, beans or tuna. Main meal - meat, fish, cheese, egg or pulses and potatoes, rice, bread or pasta and vegetables with added butter or white sauce or a small salad with mayonnaise or salad cream. Puddings - thick and creamy yoghurts, tinned fruit with evaporated milk or ice cream, mousse, full fat milk puddings eg rice pudding, custard, trifle, milky jelly or crème brûlée. Snack ideas Savoury - cheese and biscuits, nuts, toasted crumpets, with butter and cheese, soup with added cream or full fat milk, toasted bagel with butter and cheese, sausage rolls, samosas, crisps, pork pies, peanuts, other nuts. Sweet - thick and creamy yoghurts, individual mousses or trifles, ice cream, chocolate bars, cakes, pastries, toasted teacakes, biscuits, breakfast cereal with fortified milk and occasionally: boiled sweets, toffees. 8 5

8 Nourishing Drinks Milkshakes / Smoothies Banana Milkshake - Add 1 banana, ½ pint cold fortified milk, a pinch of cinnamon and 1 tablespoon of double cream to a blender. Blend for seconds and serve. Iced Coffee - Dissolve 2 tablespoons of coffee in a little warm milk. Top up with 1/3 pint of full fat milk, 2 tablespoons of sugar and 1 scoop of ice cream. Whisk and chill before serving. Milky Moment - Add 1-2 tablespoons of vanilla ice cream or double cream to 1/3 pint of milk and 1 tablespoon of skimmed milk powder. Add a choice of flavoured milkshake powder, drinking chocolate or pureed fruit/soft fresh fruit. Banana Chocolate Smoothie - Mix 1 tablespoon of full fat natural yogurt and ¼ pint of full fat milk together. Add 1 banana and a choice of either 1 teaspoon smooth peanut butter or ½ tablespoon of chocolate spread. Blend and serve. Milk Based Drinks Use fortified full fat milk to make up the following drinks: - Hot milky drinks - Ovaltine, Horlicks, Milo, Bournvita, hot chocolate, milky coffee. You can also add 1 tablespoon of double cream to hot milky drinks. - Cold milk drinks - milkshakes made with cordials, fruit juice, milk shake syrup or powder. Add a scoop of ice cream. Try fruit smoothies made from fruit blended with full fat milk, ice cream, full fat yoghurts and honey or malt. - Savoury drinks - (made with full fat milk) instant soups, Bovril or Marmite. - Yoghurt drinks - can be purchased or make your own with full Fat milk and yoghurt. Fruit Yogurt Drink - Mix 2 tablespoons of full fat fruit yogurt and ¼ pint of full fat milk together, add pureed fruit or soft fresh fruit tinned. Mango Milkshake Mix 100g of mango pulp, 200ml of full fat milk and 100ml of full fat plain yoghurt (eg Greek yoghurt), with a spoon or in a shaker/blender. 6 7