Eating well with a small appetite

Read our guide below which covers practical tips on how to eat well with a small appetite.

You can also download a PDF version of this patient information by following the link on the right.

It’s common for people to lose weight before they’re diagnosed with cancer or during treatment. Many people find that they lose their appetite when they’re having treatment or feel unwell as a result of their cancer.

It’s hard to feel enthusiastic about preparing food and eating well when you have  a poor appetite and feel fatigued. By eating as well as you can, you give your body the energy and nutrients it needs to rebuild damaged cells, fight infection and cope with the side effects of treatment. This will hopefully help you recover more quickly.

This information will help if you:

• have a poor appetite and you’re not eating as well as usual
• need a high energy/high protein diet to help prevent weight loss and maintain your energy levels.

We want to help you:

• to enjoy your food
• eat regular meals and snacks, for example 3 small meals and 2 extra snacks per day
• add extra calories and protein to foods  (food fortifying)
• have a variety of foods so that you don’t miss out on essential nutrients including vitamins and minerals
• try some energy saving ideas so that you can pace your activities and preserve your energy levels.

We’ll help you to avoid:

• choosing low fat, low calorie or ‘diet’ foods and instead opt for the high calorie, high protein versions
• low calorie or ‘diet’ drinks and instead try some homemade nourishing drinks.

Fortifying foods

If you have a poor appetite you’re eating as well as normal, the following tips may help you to get more calories (energy) without necessarily eating more quantities of food.

How to fortify milk

• Add 4 tablespoons of skimmed milk powder for example, Marvel, supermarket own brand to a pint of full fat milk
• Use this instead of your ordinary milk on breakfast cereal, in milky drinks, custard and mashed potato
• Store in the fridge and use within 24 hours.

How to fortify savoury foods

For soups, add:

• cream
• grated cheese
• milk powder or evaporated milk
• puréed beans or lentils
• ground nuts
• croutons.

For sauces, add:

• butter or margarine
• cream
• full fat natural yoghurt
• grated cheese
• ground nuts.

For mashed potato, add:

• cream
• butter, margarine or olive oil
• grated cheese
• full fat mayonnaise or salad cream.

For vegetables, add:

• butter
• margarine or olive oil
• grated cheese
• full fat natural yoghurt
• full fat mayonnaise.

How to fortify sweeter foods

For puddings, for example sponge, crumbles and pies, serve with:

• custard
• full fat yoghurt
• cream
• fromage frais
• evaporated milk.

Use ice cream, sorbets and nuts for extra toppings.

For breakfast cereals, serve with:

• fortified milk
• evaporated milk
• full fat yoghurt
• cream.

Use sugar, honey, golden syrup, puréed fruit and nuts for extra toppings.

For toast, crumpets, toasted tea cakes, muffins, spread liberally with:

• butter / full fat margarine
• chocolate spread
• lemon curd
• cream cheese
• jam
• marmalade
• peanut / almond nut butter.

For milky puddings use full cream milk or evaporated milk to make:

• milk jellies
• Angel Delight
• instant whips.

For milky drinks use fortified or evaporated milk to make your favourite drink, for example, hot choccolate, cappucino or malted milk.

Plant based diets

Non-dairy milk alternatives

If you prefer to use non-dairy milk alternatives, good options are soya*, almond, and oat milks. Choose full fat, non-organic varieties fortified with vitamins and minerals.

*Soya products contain more protein than most oat, rice or almond based dairy alternatives. Current evidence shows that 2 soya servings (equivalent to 400ml /day soya milk) are considered safe for women with breast cancer.

Practical ways to increase protein intake on a plant-based diet

Food	Protein / 100g	Portion providing 20g of protein	Tips for use
Gram flour (milled chickpeas)	23g	73g	Use to make pancakes or flatbreads, pakora, poppadums and bhajis, and vegetable fitatta type dishes.
Tofu (soya bean curd)	8g	250g	Scramble with turmeric and black salt. Add silken tofu to noodles soups or miso.
Peanut flour	48g	42g	Mix with coconut cream, maple syrup and soy sauce to create satay-type sauce. Brush onto mushrooms before grilling or thin with coconut milk for use in stir fries. Add to porridge, overnight oats and smoothies.
Powdered peanut butter	50g	40g	Sprinkle onto porridge, blend into smoothies, stir into batters.
Ground almonds	21g	95g	Add to porridge or overnight oats. Use as a flour alternative in baking.
Seitan (made from wheat gluten)	26g	77g	Use as a meat alternative in stir-fries, curries, fajitas or tacos.
Chickpea pasta	20g	100g	Use instead of wheat pasta. Add to soups or stews.
Soya mince (TVP)	52g	38g	Add to vegetable chilli, bolognaise, or curries.
Foods modified to increase protein			High protein bread, bagels, breakfast cereals, snack bars, soya yoghurt and soya. Check labels for nutritional values.

Find out more about plant based diets if you’ve lost weight or are underweight.

Meal ideas

For breakfast these include:

• cereal or muesli with full cream or fortified milk. Add sugar, honey or sliced banana
• porridge made with full cream or fortified  milk. Add golden syrup or dried fruit as a topping
• bread, toast or croissant with butter and jam, chocolate spread or peanut butter
• scrambled egg (make sure the eggs are well cooked through) or baked beans on toast
• full fat Greek or soya yoghurt with honey and soft or stewed fruit as a topping

For lighter meals these include:

• fortified soup with bread and butter
• toast with beans, cheese, egg, ravioli or tinned spaghetti
• sandwiches with meat, cheese, fish or egg
• jacket potato with cheese, beans or tuna
• pizza slices with a small salad.

For main meals these include adding:

• a protein source for example meat, fish, egg or pulses
• a starchy carbohydrate source, for example potatoes, rice, bread or pasta
• butter or oil to vegetables
• a creamy sauce for extra calories.

For puddings these include:

• thick and creamy yoghurts/mousse
• tinned sponge puddings with cream or ice cream
• milky puddings, for example rice pudding, egg custard, trifle, milk, jelly, crème caramel, crème brûlée, soya desserts or trifles.

Snack ideas

For savoury snacks these include:

• cheese and biscuits/crackers/oatcakes
• toasted crumpets with butter and cheese
• toasted bagel with butter and cheese
• pitta bread or breadsticks with humous or taramasalata
• feta cheese and olives
• finger sandwiches without crusts and with a soft filling for example, tuna mayonnaise, cream cheese, peanut butter.

Other ideas include:

• sausage rolls, cocktail sausages, pork pies
• samosas, pakoras, onion bhajis
• poppadums with chutney
• spring rolls or sesame toast. Try dipping into sweet chilli sauce
• crisps/prawn crackers
• tortilla chips/nachos. Try eating with guacamole, salsa or soured cream
• peanuts, cashew nuts, pistachios, brazil nuts, walnuts.

For sweet snacks these include:

• thick and creamy yoghurts, mousses, trifles, ice cream
• cakes, pastries, toasted teacakes, croissants, malt loaf
• chocolate biscuits or mini chocolate bars
• cereal bars, flapjacks, chewy oat bars,
• dried fruit mixtures for example, raisins, cranberries, apricots, dates, figs, sultanas
• boiled sweets, toffees, mints, jelly babies, marshmallows.

Nourishing drinks

If you’re struggling with solid food, you may find some of these drinks easier to manage.

Milky drinks

Use fortified full fat milk to make:

• hot milky drinks, for example, Ovaltine, Horlicks, Milo, Bournvita, hot chocolate, milky coffee. Add 1 tablespoon (tbsp) of double cream to hot milky drinks
• cold milk drinks, for example, milkshakes made with cordials, fruit juice, milkshake syrup or powder. Add a scoop of ice cream
• fruit smoothies made from fruit blended with full fat milk, ice cream, full fat yoghurts and honey or malt
• savoury drinks, for example instant soups, Bovril or Marmite made up with full fat or fortified milk
• yoghurt drinks or smoothies – make your own with full fat milk or yoghurt.

Homemade recipes for nourishing milkshakes and 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 10 to 15 seconds and serve.

Iced coffee

Dissolve 2 tablespoons of coffee in a little warm.

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 to 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.

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 (for example, Greek yoghurt), with a spoon or in a shaker/blender.

Tips

Add 20g vitamin fortified milkshake powder, for example, Nesquik or Tesco milkshake mix to your nourishing drink for added vitamin and minerals.

You can make high protein shakes and smoothies using 300ml of plant-based dairy alternative and one scoop of protein powder (provides approx. 20g protein depending on brand and liquid used).

More recipes

Homemade fortified milky drinks

Homemade fortified dairy free drinks

Homemade fortified fruity drinks

Supplement drinks

You can buy these from most pharmacies and supermarkets in a range of sweet, savoury and neutral flavours.

Powdered drinks, that you make with full fat milk) include Complan, Meritene and Aymes Retail.

Ready to drink versions include Complan Smoothie, Nurishment and Nurishment Extra. Huel Ready to Drink 500ml provides a plant-based option for an over the counter supplement drink.

If your food intake and weight hasn’t improved within 4 weeks and you continue to lose weight, ask your nurse or doctor for a dietitian referral. Or contact your GP who may be able to advise you about nutritional supplements available on prescription.

Should I take a vitamin and mineral supplement?

If you’re struggling with a poor appetite or reduced food intake, you may not be getting all the nutrients you need. Your diet and may benefit from taking a multivitamin and mineral supplement. People following a plant-based diet should take a multivitamin and mineral supplement suitable for vegans.

Choose a product that has approximately 100% reference nutrient intake (RNI) for all nutrients. Suitable options include Sanatogen, Superdrug, Boots or supermarket own brand A-Z multivitamin and mineral supplements. If you struggle to take whole tablets, try a chewable option for example, Centrum Fruity Chewables or Superdrug chewable A-Z.

We don’t recommend high dose vitamin and mineral supplements as they may interact with your cancer treatment. If you have any questions about other supplements or food additives, talk to your health care professional.

Vitamin D

It’s difficult to get enough vitamin D from diet alone. The main source of the vitamin is skin exposure to sunlight.

All adults should consider taking 10 mcg per day during the winter months. Some ‘at risk’ groups should consider taking a daily supplement of 10 mcg /day all year round. This includes people over 65, and those who cover their skin when outside.

Is it safe to take probiotics?

The beneficial bacteria found in certain food products or supplements may benefit your health by improving the types of bacteria in your gut (bowel). But if your immune system isn’t working properly or you’re having chemotherapy, you shouldn’t take them until 14 days after finishing your treatment.

There isn’t enough evidence to support taking probiotics during immunotherapy treatment.

Should I follow an alternative diet for treating my cancer?

There are several alternative diets claiming to treat or cure cancer. Some of these diets recommend avoiding certain foods or taking large doses of vitamins and minerals.

There’s no scientific evidence that these diets can make the cancer shrink, cure the disease or reduce recurrence. These diets are potentially harmful because they’re often low in calories and protein, and tend to be high in fibre making them very filling.

They can cause weight loss and potentially serious nutritional deficiencies in people who already have problems eating due to their cancer treatment. If you’re thinking of following an alternative diet, talk to your consultant, nurse specialist or specialist dietitian.

Helpful hints if your appetite’s poor

You could:

• let someone else do the cooking if you can as the smell may affect your appetite
• use foods that are easy and less energy consuming to prepare
• have small frequent meals and snacks every 2 to 3 during the day instead of 3 meals.
• make the most of the times when you do feel hungry
• keep snacks handy to nibble on, such as crisps, nuts, biscuits, dried fruit
• take a short walk outside in the fresh air or have a small glass of your favourite wine or sherry which may help to stimulate your appetite before a meal.

You should also:

• avoid filling yourself up on too much fluid before a meal
• eat meals slowly, chew the food well and relax for a while after each meal.

If you find cooking difficult, try ready-prepared meals either from the supermarket or delivered to your home from Wiltshire Farm Foods or Oakhouse Foods.

Energy saving ideas

Planning ahead, pacing and listening to your body may help to offset tiredness and fatigue that makes daily activities difficult. It may help to manage weight loss.

Planning ahead

You should:

• identify tasks which cause extreme tiredness
• ask others for 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 example, sitting or perching instead of standing
• organise tools and materials in the work area, for example, in the kitchen, and store items within easy reach.

Pacing activities

The aim is to avoid exhaustion. Many activities don’tt need to be done quickly or all at once.

Try taking things more slowly and take planned breaks before you get tired.

Save some tasks for later in the day or even the next day. I’ts easier to keep some small reserves for the next task than to build those reserves after they’re depleted.

Listening to your body

When we perform everyday tasks, we tend to be in ‘automatic’ mode, but this isn’t 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 tells you before, during and after activities.

For example try looking closely at one particular task (shaving, dressing, bathing etc). Ask yourself:

• when does the feeling of significant tiredness begin?
• are there natural breaks in the task?
• could I sit down to do the activity?
• is there someone who could help me? for example, my GP, district nurse or social worker.

For expert advice and assessment related to pacing and equipment, ask for a referral to an occupational therapist.

Further reading / recommended references:

• Food fact sheets from the British Dietic Association
• Diet and cancer
• Macmillan Cancer Support
• Eat well during cancer
• Be healthy Bucks
• The eatwell guide from NHS Choices
• Nutrition and living with cancer helpline

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 prevention and control is important to the wellbeing of our patients so we have procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections.

You, and anyone visiting you, must use the hand sanitiser available at the entrance to every ward before coming in and after you leave. You may need to wash your hands at the sink using soap and water. Hand sanitisers are not suitable for dealing with patients who have symptoms of diarrhoea.

More help or advice

Contact our patient advice and liaison service (PALS) on 01296 316042 or bht.pals@nhs.net