• Reference Number: HEY1436-2024
• Departments: Dietetics, Nutrition Support
• Last Updated: 1 February 2024

Introduction

Often people with kidney problems have a reduced appetite.  There are many reasons for a poor appetite; it can be due to tiredness, taste changes or feeling sick.  This can cause you to lose weight.

If you are unable to eat enough, it is important to plan how to get the nutrition you need.  A nutritious diet can:

• Help prevent weight loss or help regain weight you may have already lost.

• Prevent the body from breaking down its own stores of fat and muscle.

• Help your body to fight infections more effectively.

• Build up your strength.

In this leaflet you will find helpful suggestions on how, with even a small appetite, you can make your diet as nutritious as possible. Note while your appetite is poor you may be able to have some foods that you usually limit or avoid. For example if you have diabetes or are following a low potassium or low phosphate diet. Your dietitian well help guide you with this.

If you have diabetes and treat this with insulin you may need to adjust your dose when not eating well, please consult with your diabetes nurse for more advice and guidance.

Once your weight and appetite have improved sufficiently, you may not need to follow this advice anymore.  Your dietitian will monitor your progress and provide advice as needed.

Ready meals, meal delivery services and online shopping

You may find that your energy levels change throughout the week and that some days you may feel better than others.

Tips:

• Make the most of ‘good days’ by preparing extra meals which you can store in the fridge or freezer as individual portions for ‘not so good days’.

• When you are feeling unwell and unable to prepare a meal, ready meals or meal delivery services are often good alternatives.

• Consider buying a selection of ready meals to store in the fridge or freezer for ‘not so good days’.

• Most supermarkets offer online shopping and home delivery services which may make shopping easier for you.

• Social services can provide you with information on a variety of options such as Meals on Wheels, lunch clubs, day centres, voluntary organisations, Wiltshire Farm Foods or Oakhouse Foods. If you need extra help with arranging this, ask your dietitian or specialist nurse.

General tips and hints to improve your appetite

If your appetite is small or you feel full quickly, eat little but often.  Aim for 3 small meals and 2 to 3 snacks per day; or just 5 snacks a day, try to eat every 2 to 3 hours.

Avoid low fat/diet/light versions of foods and drinks, instead choose:

• Butter on toast/mashed potato/scrambled eggs
• Whole milk (blue top) in cereal/mash/scrambled eggs
• Double cream or crème fraiche in puddings/mash
• Cheese in mash/on toast
• Mayonnaise/salad cream on salads/new potatoes
• Honey, syrup or treacle in porridge
• If you use soups ensure these are ‘cream of’ soups
• Choose ‘Greek’ or ‘thick and creamy’ yoghurts

Choose foods you enjoy eating and that are easy to prepare, you are more likely to eat more of these.

Aim to have at least one pudding per day, sometimes these can be easier to manage than a savoury snack.

Fresh air and spending time outdoors can improve your appetite.

Do not have a drink before or with your meals.

If you are finding food tasteless, try adding herbs and spices to give it more flavour.

Meal ideas

Breakfast

 Many people find that breakfast is the time when their appetite is at its best.  If that is the case, make the most of this and add extra energy where possible.  If you cannot eat when you first get up, delay your breakfast until later in the morning.

Try:

• Breakfast cereal with whole milk and sugar, honey or ham
• Porridge made with whole milk and cream, with sugar, jam, honey or syrup
• Toast or croissant with plenty of butter/margarine and jam, marmalade, honey, peanut butter or cheese. Butter the toast when hot to add extra energy
• Croissant, bread or English muffins with cheese and ham
• Scrambled, boiled or fried eggs with bread or toast and plenty of butter/margarine. Try to add some butter and cheese, tomatoes, ham or smoked salmon to your scrambled egg
• A buttered filled roll with bacon, sausage or egg
• Crumpets, pikelets or bagels with butter/margarine and jam, marmalade or cream cheese
• Kippers or smoked haddock with bread and butter
• A glass of whole milk and biscuits with butter/margarine or cream cheese
• Full fat Greek yogurt with some berries and honey
• Curry or dahl with added yogurt and a roti

Snack/cooked meal ideas

• Toast with butter/margarine and scrambled egg, bacon, cheese, tinned spaghetti, baked beans, toast toppers, sardines, mackerel or peanut butter
• Sandwich roll, pitta pockets or wraps with various fillings; for example, cheese, egg, cold meat, tuna, salmon or sandwich fillers. Be generous with butter/margarine and add in extra mayonnaise or salad cream
• Omelette or frittata made with cheese, ham or peppers and boiled potatoes with vegetables or salad. Add extra dressing to your salad for extra energy
• Quiche with boiled potatoes and vegetables or salad
• Macaroni cheese or tinned ravioli with grated cheese
• Sausage and baked beans with mashed, boiled or tinned potatoes, chips or fried egg
• Jacket potato with extra butter and cheese with salad
• Roast chicken, beef, lamb or pork with vegetables with cheese sauce and potato
• Salmon with hollandaise sauce
• Fried white fish with parsley or cheese sauce
• Stir-fry chicken, beef or pork with vegetables and sauce e.g. sweet and sour or black bean with rice or noodles, couscous or boiled potatoes
• Lasagne, Spaghetti Bolognese or Moussaka served with garlic bread
• Quinoa, lentil and feta or halloumi salad with vegetables. Add extra cheese or olive oil
• Soup – homemade, carton or tinned with a roll or sandwich. Add extra butter/margarine, cream or cheese for energy
• Curry or dahl made with cream or coconut milk

Puddings

 Aim to have at least one pudding per day. If you are unable to eat a savoury course, sometimes puddings are easier to manage.

Suggestions:

• Individual ready-made desserts such as trifle, cheesecake, sponge pudding, mousse, ice-cream, full fat yoghurt or fromage frais
• Sponge cake, fruit crumble or fruit pie served with cream, crème fraiche, custard or ice cream
• Tinned, pureed or stewed fruit and cream or meringue/pavlova
• Milk puddings e.g. rice pudding, semolina, sago or custard

Snack Ideas

If you are only managing small meals, try to have 2 to 3 snacks in between meals.  Aim to have something to eat every 2 to 3 hours.

Biscuits – plain, cream filled, custard creams, digestives, jammie dodgers, iced gems, shortcake, wafer biscuits.

Cakes – cream horns, cupcakes, doughnuts, ginger cake, iced buns, jam tarts, Madeira cake, sponges (plain, jam and cream filled), jam Swiss roll, meringues.

Sweets – Marshmallows, jelly beans, gum drops, lollipops, mints.

Breads and spreads – bread, toast, crackers, crumpets, scones, muffins with butter/margarine and jam, marmalade, honey, golden syrup, cream cheese or sandwich spread.

Savoury snacks – mini sausages, scotch eggs, pork pies, pasties, sausage rolls, tortilla chips, maize snacks rice crackers, oatcakes, poppadums’/tortilla chips/breadsticks/toast and dips e.g. hummus/onion and garlic dip.

Note: Savoury snacks are often high in salt and can make you thirsty. This may make it harder for you to stick to your fluid allowance if you have one.

Suggestions to add extra energy or protein to your meals

Discuss how best to enrich your diet with your dietitian if you have any health conditions that require you to limit the fat and/or sugar in your diet.

Extra tips if you are on dialysis

• It is a good idea to have a protein containing snack when you are on dialysis e.g. tuna sandwich, houmous with pitta bread or oatcakes with soft cream cheese. 

• If you can’t manage a full meal after dialysis, try to have some small snacks during dialysis and a light meal, sandwich or snack afterwards. 

• If your appetite is better on dialysis, try bringing extra snacks to have during your session. 

• If you miss meals because of dialysis transport, try to bring some packed food with you to eat while waiting. 

• If you feel better on a non-dialysis day, try preparing and cooking extra portions of your meals so that you have a meal ready for you in your fridge or freezer after dialysis. 

• If you feel bloated from your peritoneal dialysis (PD) fluid, try eating an hour or two before or after your exchange and try and make sure you have some snacks between your meals. Discuss this with your PD nurse who may be able to alter your PD regime. 

If you are losing body weight, it is important to let your dietitian and the specialist nurses know to make sure fluid doesn’t build up.

Extra tips if you are not on dialysis

• If you are suffering with nausea or vomiting you may find that cold foods are better tolerated e.g. cereal, sandwiches etc. If possible try to get someone else to do the cooking as often cooking smells can make nausea worse.
• Eat slowly and give your food time to settle by relaxing after meals in a sitting or slightly reclined position, instead of lying down.
• Have drinks in between meals.
• Aim to get extra calories from carbohydrate and fat rather than protein foods, this leaflet has suggestions to fortify your diet.
• If you are suffering from taste changes adding extra herbs, spices, garlic, ginger or chilli to your food often helps.
• Tart, sharp foods such as lemon mousse or sorbet often taste better.
• If you suffer from a metallic taste you could try using plastic or wooden cutlery, and non-metallic dishes and cookware to see if this helps.

Supplements

If your appetite remains poor and you are still losing weight then your dietitian may discuss some nutritional supplement drinks for you.  These are to supplement your food intake and should be taken in between meals to add extra calories and protein to your diet.  They are not a substitute for your usual food and drink.

Should you require further advice, please do not hesitate to contact the Dietetics Department on tel: 01482 674490