Renal - Nourishing diet for people with kidney disease

You have been given this leaflet because you have a poor appetite and/ or you have lost weight. This leaflet will provide information to help you make small changes to what you normally eat to make your diet as nutritious as possible.

If you are following a special diet because of your kidney disease, this can be relaxed if you are not eating well.

The section at the end of this leaflet has more information on relaxing your diet. If you are unsure, speak to your dietitian.

Losing weight, having a reduced appetite or being dehydrated can worsen illness, cause illnesses to last longer and make it more difficult for your body to respond to treatment for your kidney disease and other conditions.

Signs of under nutrition

• Unplanned weight loss
• Loss of appetite
• Loose fitting clothes/jewellery
• Ill-fitting dentures
• Tiredness
• Sores around lips
• Hair loss

Signs of dehydration

• Dark coloured urine (should be straw in colour) or strong smelling urine
• Dry mouth
• Dry skin
• Loss of appetite
• Light headedness or headaches

Some people with kidney disease find it difficult to eat well because food tastes different, or because they feel sick often.

To help with taste changes

• Try sucking mints/sharp tasting fruit sweets/candied ginger/ chewing gum
• You may find you enjoy savoury foods more than sweet ones
• If red meat tastes unpleasant, see if fish/chicken/eggs or vegetarian alternatives (eg quorn/tofu) taste better
• Try apple sauce/mint sauce with meat/poultry
• Sipping drinks through a straw can avoid some of the taste buds and cut down unpleasant tastes
• If you have a metallic taste in your mouth, try using plastic cutlery instead of metal

Top tips to improve your intake

• It is important to have small regular meals and snacks in between. Remember you can also go back for seconds
• Try to eat something every 2-3 hours even if it is only something small
• Have puddings or desserts at least once a day – if you are too full after a meal wait 30 minutes before having dessert
• If you smoke, try not to smoke half an hour before your meal
• Getting a small amount of fresh air before meals can help stimulate an appetite
• Take drinks after meals rather than before or with meals to avoid feeling too full or bloated
• Make the most of ‘good days’ or times during the day when you feel more like eating
• Try some of the suggestions in this leaflet for 4 – 6 weeks. If you are still concerned or losing weight after this, please contact your dietitian

How to fortify your meals by adding extra calories:

Foods can be ‘fortified’ to be made more nourishing. The suggestions below will add calories to your food and can also increase your energy levels:

• Add oil, margarine, mayonnaise, cream, cheese, cream cheese to vegetables or mashed potatoes (one portion per day)
• Add cheese, cream cheese or cream to soup, scrambled eggs or sauces
• Add extra ice-cream, cream, or custard to stewed/tinned fruit, cake, milky puddings and pies
• Spread thick margarine or mayonnaise on bread or chapatti
• Add cream, croutons, or pasta to soup – choose ‘cream of’ or ‘condensed’ varieties (avoid mushroom, potato and tomato soups)
• Add mayonnaise, salad cream and dressings generously

Too tired to cook?

There are plenty of meals that you can buy ready-made which can be heated in a microwave or oven, making them quick and convenient. Avoid low fat ready meals. Try to choose meals that are lower in salt.

Add cheese, cream cheese or cream to ready meals such as cottage pie, fish pie and pasta dishes.

There are also a variety of ways to have your meals delivered:

• Wiltshire Farm Foods
• Meal-on-wheels
• Oak House Foods
• Voluntary organisations and
• Supermarket home deliveries

Ideas for quick and easy meals:

• Try different toppings to toast e.g. cheese, cream cheese, scrambled egg or spaghetti
• If you have a toasted sandwich maker you could make a hot snack by having ham, tomato and cheese or cheese and pickle toasties
• Or you could have a cold sandwich. Try: cheese, cream cheese, tuna mayonnaise or other fish, egg mayonnaise, jam or cold meats (e.g. beef or ham)
• Mashed or boiled potatoes (one portion per day) – with margarine, mayonnaise, tuna, coleslaw and don’t forget to add cream, cheese or cream cheese for extra calories
• Soups – these can be quick and nutritious meals whether they are tinned or homemade. Try to choose lower salt options. Choose ‘cream of’ varieties and add extra cream
• Sausage rolls, pasties, pies, quiches, or scotch eggs that you can nibble on in between meals or to have as part of a meal

Snack ideas for a nourishing diet

If your appetite is poor or if you are losing weight it is important to have small regular meals. Eating more at mealtimes can be difficult at this time. So why not have some snacks and drinks in- between your meals?

100-200kcal - High energy:

• 1 Chocolate biscuit bar e.g. Club, Penguin, Snack, Kit Kat
• Cereal bar e.g. Nutri-Grain, Alpen, Brunch (choose ones without nuts, seeds or dried fruit)
• Packet of wheat or corn snacks (e.g Doritos, skips)
• Thick and creamy yoghurt.
• 2 biscuits e.g bourbon, custard cream
• Individual trifle, mousse, custard pot or rice pudding
• Jam/bakewell tart
• 1 slice Victoria sponge or madeira cake
• 1 mini sausage roll
• Cheese portion
• Garlic bread

200-300kcal - Very high energy:

• 3 crackers with margarine and cheese/cream cheese
• 1 jam/ring doughnut
• 1 chocolate éclair
• 1 medium Flapjack (choose versions without nuts or seeds)
• 1 medium sausage roll
• Egg custard tart
• Medium pork pie
• Pancake with margarine and jam
• 1 toasted English muffin with margarine
• 1 medium sausage roll
• 2 digestive biscuits with butter and cream cheese

Over 300kcal - Super high energy:

• 1 medium Danish pastry
• Cheesecake – 1 medium slice
• Cream cake (e.g cream horn, cream fruit turnover)
• Iced cupcake
• Iced sponge cake slice

Store cupboard ideas

• Long life full fat milk
• Breakfast cereal and porridge
• Jam, marmalade, honey, macaroni cheese and spaghetti
• Tinned fish
• Tinned vegetables and fruit - add margarine, mayonnaise or cream to these
• Tinned custard, sponge and custard and rice pudding

In the freezer

• Instant/ready-meals e.g cottage pie, fish pie, roast dinner
• Full fat ice-cream
• Frozen vegetables
• Frozen fruit eg mixed berries
• Frozen desserts eg jam roly poly, crumbles, gateaux, sponge puddings
• Bread can be stored in the freezer and defrosted in the toaster
• Portions of home cooked foods

Always choose full fat versions. Try to choose lower salt options where possible.

Getting the balance right

Even when you appetite is poor, it is still important to include foods from the different food groups. Always choose the most nourishing option.

If you have been asked to limit certain foods in the past, these limits can be relaxed if you are not eating well. See below for more information.

If you are diabetic and you are not eating well, restrictions on sugary foods that you have been followed can usually be relaxed. If you are worried about this, or you know that your blood glucose (also called blood sugar) levels are high, speak to your dietitian before relaxing your diet.

Protein:

Meat and fish or alternatives including eggs, tofu, quorn:

• Include a source of protein 2 times a day

Carbohydrates:

Potatoes, bread, pasta, rice and breakfast cereals:

• Provide energy, fibre, vitamins and minerals – aim to include a carbohydrate with each meal
• Only have one portion of potato per day. Make sure these are pre boiled in plenty of water before using for boiled, mash, roast or chipped potatoes
• Choose cereals that do not have nuts seeds or dried fruit in them

Fruit and vegetables:

• Aim for 4 a day but do not fill up on these if they replace other more high calorie foods.
• Can use tinned (drain tinned fruit and throw away the water/ juice) or frozen fruit and vegetables instead of fresh
• If you have been asked to restrict the potassium in your diet, try to stick to lower potassium fruits and vegetables. Ask your dietitian if you are unsure
• If you have been asked to restrict the potassium in your diet, avoid tomato, mushroom, or potato soups
• Add oil, margarine, mayonnaise or cream to vegetables

Milk and dairy:

• Good source of energy, protein and calcium
• If you have been asked to restrict the amount of milk you have in a day, this can be relaxed while you are not eating well. Do not have more than one pint (600ml) per day
• If you have been asked to restrict cheese in the past, stick to your 100g per week limit for hard cheese (cheddar)
• Use more soft light coloured cheeses (e.g. soft spreadable cheese, cottage cheese, brie, ricotta) and cream instead of extra cheese or milky puddings
• If you have been asked to restrict milky puddings (yoghurts, custards, rice puddings), this can be relaxed to one per day

Energy dense foods: high fat and high sugar foods:

• Add margarine, vegetable, sunflower or olive oils, mayonnaise, salad dressings, cream cheese or cream to foods

Fluid:

• If you have been told to stick to a certain amount of fluid in a day (often called a “fluid allowance” or “fluid restriction”) continue to stick to this
• If you have not been told to stick to a certain amount of fluid in a day, aim for six to eight cups (about 1.5-2 litres) per day

This information has been provided to help answer any questions you might have if you have a poor appetite. If you have any further questions or concerns, please contact your dietitian:

Contact details

Renal Dietitians - 0161 206 1994
Monday to Friday, 8.00am-4.00pm, excluding Bank Holidays
email: renaldietitians@nca.nhs.uk