Building yourself up in a healthy way Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm

The human body requires extra calories during periods of illness and whilst recovering, to prevent weight loss and maintain muscle mass and strength. Many people experience temporary loss of appetite but if this continues, weight loss and nutritional deficiencies can occur. In this situation there are ways to make your diet more nourishing. If a person is overweight they can still become malnourished if they have a poor appetite and are unintentionally losing weight. Significant unintentional weight loss is defined as unplanned weight loss of 5–10% of your starting weight. When a person has a poor appetite, there are ways to adapt the diet to limit weight loss, as much as possible, whilst still maintaining a healthy diet. It is important that enough calories, protein, vitamins and minerals are consumed to aid recovery and prevent weight loss, while still maintaining a diet that will not be damaging to your health, particularly heart health in the long term. You may find this booklet helpful if: • You are losing weight unintentionally • Are underweight or have been advised you have a low BMI There is also a patient information leaflet discussing how to cope with taste changes. If you feel your taste has changed and this is affecting your diet, appetite and weight, please ask to speak with a Dietitian and this can be discussed in more detail.

Consuming more calories and protein in a heart healthy way Protein is a nutrient found in certain foods which helps to repair body tissue and maintain the immune system. During times of illness, infection and recovery, the body often uses more protein. It is therefore important to include sufficient protein in the diet to prevent muscle wasting and weight loss during these times. Protein rich foods include; meat (with skin and fat removed), fish, eggs, quorn, tofu, dairy products, beans and lentils. Calories in food are what give us energy, if not enough calories are consumed, weight loss will occur. A diet high in calories can help to prevent weight loss and increase weight if required. 2 | PI_1610_01 Building yourself up the healthy way

Even though the amount of calories and protein in the diet has to be increased, a relatively healthy diet still needs to be maintained to ensure long term heart health is not affected. The following information provides guidance on getting this balance right. Adapting the types of fat in your diet is a good way of increasing calories while still maintaining a healthy cholesterol level. There are two main different types of fat; saturated fat and unsaturated fat. Both these fats contain the same amount of calories and energy. Saturated fats mainly come from animal sources and are found in butter, cheese, pastry and cakes as well as the visible fat on meat. These fats can have a negative effect on cholesterol levels and can damage the health of your heart. Unsaturated fats mainly come from plant sources; these have been shown to be beneficial for the health of your heart and arteries as they have a positive effect on cholesterol levels. Ways to increase unsaturated fat in your diet; • Snack on a small handful of unsalted nuts or seeds, along with dried fruit* • Add rapeseed or olive oil to salads and vegetables • Try avocado mashed on toast or with a meal as a vegetable • Use peanut butter as a topping on toast or oatcakes with jam* • Increase your intake of oily fish for example; mackerel, salmon, pilchards and sardines (tinned are suitable), these are high in calcium and omega 3 oils. Aim for one portion or one tin, once a week (100–150g) All foods with * can be high in sugar and should be limited in those with type 2 diabetes.

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If your appetite is poor When your appetite is poor, you may find that large portions of food are off putting. It may be easier to have small meals together with small, regular snacks – to eat little and often. This will help to make sure you are getting enough calories and energy. You should aim to have three small meals and three snacks in between meals each day. At each meal you should make sure you have a portion of starchy food such as; • Bread • Potatoes • Rice, pasta, maize or corn meal • Green banana or plantain • Crackers, crisp bread or oatcakes Starchy foods are broken down into energy (calories) so it is important to base meals around these foods by having them at every meal time. With at least two of your meals, you should aim to have a portion of protein foods such as: • Meat, poultry or a vegetarian alternative for example; soya protein • Fish • Eggs • Lentils or beans Milk is a nourishing drink so aim to have one pint of milk per day. This can also be used in hot drinks and with cereals. Dairy alternatives for example; soya, rice or oat milks which are fortified with calcium can be used instead of milk as a healthy alternative or if cows milk is not tolerated. Adding extra calories and nourishment to meals makes food more concentrated with energy without adding extra bulk. Techniques to do this include; • Adding olive/rapeseed oil to meals for example; pasta, rice and using extra when cooking 4 | PI_1610_01 Building yourself up the healthy way

• Adding margarine or cheese to mashed potato • Adding peanut butter or jam* to porridge • Adding pesto to pasta or on a sandwich All foods with * can be high in sugar and should be limited in those with type 2 diabetes.

Small snack ideas • A pot of thick and creamy yoghurt • Handful of unsalted nuts for example; Brazil, cashew or peanuts • Rice pudding* or custard* with fruit • 2 digestive biscuits • 1 small chocolate bar or biscuit* • Plantain chips or puff puff* • Handful of chevda All foods with * can be high in sugar and should be limited in those with Type 2 Diabetes.

Small meal ideas • Jacket potato with olive oil based spread and a filling such as baked beans and grated cheese, cottage cheese and tinned peaches, tuna and reduced fat mayonnaise. • Soup with a bread roll – add extra beans, lentils or a small amount of cream or olive oil based spread • Omelette or scrambled egg with added beans, ham or grated cheese • Sardines/mackerel/pilchards in tomato sauce on toast • Peanut butter, beans or mashed banana on toast PI_1610_01 Building yourself up the healthy way | 5

• Porridge with mango and honey* • Hummus, reduced fat pate or cheese spread on crackers or pitta bread • Hard boiled egg and reduced fat mayonnaise sandwich with olive oil based spread • Bowl of cereal with added dried fruit/nuts/seeds • Slice of quiche Always try to have something to eat at every meal time no matter how small it might be. All foods with * can be high in sugar and should be limited in those with type 2 diabetes.

Nourishing fluids and drinks A simple and convenient way of getting extra calories in your diet is through drinks. These can be easier to consume if you cannot manage something to eat. You should try having drinks in–between meals, sipped slowly or before you go to bed. Nourishing drinks include: • Hot chocolate made with milk* • Malted drinks such as Horlicks and Ovaltine* • Milky coffee such as a latte and cappuccino • Flavoured milkshakes* • Build Up or Complan* (nutritional drinks) These can be made with fortified milk to increase the calories further. Fortified milk can be made easily by adding 2–4 tablespoons of dried skimmed milk powder to 1 pint of milk. All foods with * can be high in sugar (more than 15g per 100g) and should be consumed less frequently, particularly for those with type 2 diabetes. Should you continue to lose weight, have a poor appetite or fail to gain weight, please do not hesitate to speak with the dietitian or Doctor so that further support and advice can be given. 6 | PI_1610_01 Building yourself up the healthy way

Please use the space below to write down any questions you may have and bring this with you to your next appointment.

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The Trust provides free monthly health talks on a variety of medical conditions and treatments. For more information visit www.uhb.nhs.uk/health-talks.htm or call 0121 371 4323. HIV/GU Queen Elizabeth Hospital Birmingham Mindelsohn Way, Edgbaston, Birmingham B15 2GW Telephone: 0121 371 6961

PI15/1610/01 Author: Rachel Watson Date: July 2015 Review date: July 2017