What is lactose intolerance?

Lactose intolerance means that your body cannot digest lactose. Milk is made up of fats, proteins and sugar (carbohydrate). Lactose is a type of sugar (carbohydrate) that is in milk and milk products.

What are the symptoms?

• Wind 
• Bloating
• Tummy ache
• Stomach cramps
• Tummy rumbling
• Nausea (feeling sick)
• Diarrhoea (loose stools)

What are the causes?

Lactose intolerance happens when your body does not make enough lactase.

Lactase is an enzyme that breaks down lactose; it is made in the lining of the small bowel. Enzymes break down sugars into smaller parts, so that they can pass from your gut into your body.

Types of lactose intolerance

There are two types of lactose intolerance: primary and secondary.

Primary lactase deficiency

Primary lactase deficiency is a lifelong genetic condition (runs in families). It is most common in people from Africa and Asia, but anyone can have it. 2 out of 3 people in the world have this. You may produce lactase as a child, but less lactase as you grow up.

Secondary lactase deficiency

Secondary lactase deficiency is usually short term. It is due to illnesses that affect your small bowel such as coeliac disease, inflammatory bowel disease (IBD), gastrointestinal infections and abdominal surgery.
Lactose cannot be broken down or absorbed without lactase. It will pass into the colon instead. In the colon it will be fermented which makes gas. Lactose also pulls water into the bowel, which is why it can also cause loose stools.

Lactose intolerance is not the same as an allergy. If you have lactose intolerance you may be able to manage some lactose in your diet in smaller amounts. However, if you have a milk protein allergy you need to strictly avoid all milk products.

Some people do not make the lactase enzyme but do not get bad symptoms. Other people can make the lactase enzyme but still have bad symptoms. Lactose may make you feel ill but it will not do any long-term harm or hurt your body. You need to work out how much lactose is right for you and your symptoms.

Diagnosis

Hydrogen Breath Test

In this test, you drink a special high lactose drink and they test how much hydrogen gas is in your breath. If your body does not break the lactose down, the bacteria that live in your colon will ferment it. This makes lots of hydrogen gas, so a high level of hydrogen in your breath means you have lactose intolerance.

The test results are not perfect. Some people have a positive breath test but no symptoms. Some people have a negative breath test but still have symptoms. Sometimes a lactose free trial is better.

Lactose free trial

This is a good choice instead of the breath test.

Stop having lactose for a short time (about 2-4 weeks). If you do not feel better, then you do not have lactose intolerance and you can start having lactose again. You can talk to your doctor or dietitian about what else could help your symptoms.

Which foods contain lactose?

Lactose is in milk, including breastmilk, cow’s milk, sheep’s milk and goat’s milk. All products containing milk or made from milk contain lactose.

Everyone will tolerate a different amount of lactose. Most people can have a low lactose diet, but some people will need to be stricter. For example, you might be able to have a splash of milk in tea, but you might have symptoms if you had a milky coffee.

• Start by strictly avoiding lactose.
• If your symptoms get better, you can slowly increase your lactose intake.
• Most people can have some lactose. Try to spread it out through the day.

The information below shows how much lactose is in different foods.

The amount of lactose in some foods can vary. There is not an exact amount of lactose in the table for these foods, but you can see which foods are lactose free, low in lactose or high in lactose.

Food groups

If you would like a printed copy of this information in a table format, please speak to your clinician.

Milk

High lactose (more than 2g /100g)

• Cow’s milk: 4.6 - 4.8g /100g
• Sheep’s milk: 5.1g /100g
• Goat’s milk: 4.4g /100g
• Condensed milk: 12.3g /100g
• Evaporated milk: 12.7g /100g
• Dried milk powder: 52.9g /100g
• Cream alternative (Elmlea): 4g /100g

Low lactose (up to 2g /100g)

• Creme Fraiche: 2g /100g
• Cream: 1.7 - 2.2g /100g
• Soured cream

Lactose free

• Oat milk
• Rice milk
• Soya milk
• Coconut milk
• Hazelnut milk
• Almond milk
• Tiger nut milk
• Lactose free milk
• Hemp milk

Other dairy

High lactose (more than 2g /100g)

• Yoghurts: 3.6 - 4.7g /100g
• Lassi: 8.6g /100g
• Fromage frais: 2.9 - 4.1g /100g
• Custard: 4.6 - 5.4g /100g
• Rice pudding: 3.9 - 4.9g /100g
• Mousse: 5.7g /100g

Low lactose (up to 2g /100g)

• Cheesecake

Lactose free

• Soya desserts / dairy free yoghurt style
• Lactose free yoghurts

Cheese

High lactose (more than 2g /100g)

• Cottage cheese: 3.5g /100g
• Processed cheese: 6.5g /100g
• Cheese spread, e.g. Philadelphia or supermarket own versions
• Ricotta
• Mascarpone: 4.5g /100g

Low lactose (up to 2g /100g)

• Hard cheese: 0.1g /100g
• Blue cheese: 1.0g /100g
• Ripe / rind cheeses: 0.9g /100g
• Mozzarella: <0.1g /100g
• Goat’s cheese: 0.9g /100g
• Feta: 1.4g /100g
• Halloumi: 1.5g /100g
• Lactose free cheese: <0.1g /100g
• Low / reduced fat cheese
• Brie: <0.1g /100g
• Cheddar: 0.1g /100g

Lactose free

• Dairy free cheese alternative

Cereals

High lactose (more than 2g /100g)

• Yoghurt coated cereal bars
• Porridge made with milk

Lactose free

• Breakfast cereals

Bread

Low lactose (up to 2g /100g)

• Milk bread
• Some gluten free bread contains milk

Lactose free

• All other breads

Rice

High lactose (more than 2g /100g)

• Rice pudding: 3.9 - 4.9g /100g

Low lactose (up to 2g /100g)

• Risotto

Lactose free

• Rice
• Rice cakes
• Sushi

Pasta

High lactose (more than 2g /100g)

• Macaroni cheese
• Ricotta ravioli
• Lasagne

Lactose free

• Pasta with tomato sauce
• Check free from section for dairy free white sauce, macaroni cheese or lasagne

Treats/snacks

High lactose (more than 2g /100g)

• Milk chocolate
• White chocolate
• Ice cream
• Chocolate cake bars

Low lactose (up to 2g /100g)

• Cheese and onion crisps
• Cheesy puffs / corn snacks
• Biscuits
• Chocolate coated / dipped biscuits
• Cake
• Cheese crackers: <0.3g /100g
• Fudge / toffee: <1.5g /100g
• Pastry made with butter: 3.3g /100g

Lactose free

• Most crisps
• Sorbet
• Dairy free ice cream
• Jelly

Fats

Low lactose (up to 2g /100g)

• Butter
• Ghee
• Reduced fat spreads
• Margarine

Lactose free

• Vegetable oils
• Coconut oil
• Lard
• Dairy free spreads

Meat, fish, eggs and alternatives

High lactose (more than 2g /100g)

• Omelette made with milk

Low lactose (up to 2g /100g)

• Scrambled egg made with butter / milk
• Battered fish (some does have milk in, some does not)

Lactose free

• Meat
• Fish
• Eggs
• Tofu
• Quorn
• Vegan meat alternatives

Sauces / condiments

High lactose (more than 2g /100g)

• White sauce
• Ready made custard

Lactose free

• Jam
• Marmite
• Peanut butter
• Mayonnaise (check as some brands contain milk or cream)
• Ketchup
• Vinegar
• Custard powder
• Gravy
• Spices / herbs
• Chutney / pickle

Fruit, veg, nuts, pulses

High lactose (more than 2g /100g)

• Yoghurt coated dried fruit / nuts

Low lactose (up to 2g /100g)

• Mashed potato made with butter / milk
• Instant mash
• Soup containing cream

Lactose free

• All fruit and vegetables
• Baked beans
• Pulses
• Chips, potato waffles, hash browns
• Nuts

Checking labels

It is the law that if a product contains milk products they will be listed in bold, underlined, or highlighted.

The ingredients list is in weight order, with the largest first. If it is near the bottom of the list then there is a smaller amount in the food. If milk is one of the last ingredients in a long list, it might be fine.

Vegan foods are lactose-free.

Check labels for:

• Milk
• Milk solid
• Skimmed milk powder
• Cream
• Butter
• Buttermilk
• Whey

“May contain”

Most people with lactose intolerance can have a food that says “may contain milk” or “made in a factory that handles milk” or “not suitable for people with a milk allergy”.

Confusing ingredients

Casein and milk protein are sometimes listed within the ingredients and are proteins found in milk; you can have both of these ingredients. Some people have an allergy to milk protein, but this is not the same as lactose intolerance.

Medications

Some tablets contain very small amounts of lactose. Do not worry unless you take lots of tablets.

You can talk to the pharmacist about changing to lactose free medicine. Do not stop taking a medication without speaking to your doctor or pharmacist first. Lactulose (a laxative) is not the same as lactose.

Nutrients

Dairy products provide some key nutrients. You need to make sure you get enough of these. Remember that most cheese is low in lactose so it may be okay for you.

Vitamin B12

You need vitamin B12 to help with energy release, healthy blood and the nervous system.

Non-dairy sources of vitamin B12:

• meat
• eggs
• fortified breakfast cereal
• yeast extract (marmite)
• salmon
• cod

Calcium

You need calcium for bone health. Milk and dairy products are the main sources of calcium.

• Lactose-free milk contains the same amount of calcium as cow’s milk.
• If you use a milk alternative (oat/soya/coconut/nut milk), make sure it has added calcium.
• Organic milk alternatives do not have calcium added to them.
• Tinned fish with bones (sardines, pilchards, salmon) are very high in calcium.
• Oranges, almonds, brazil nuts and tofu also contain calcium but it is not so easily absorbed.

You may need to take a calcium tablet if your bone health is high risk such as:

• Breastfeeding mothers
• Post-menopausal women
• Coeliac disease
• Inflammatory bowel disease

Vitamin D

You need vitamin D to use calcium.

The body makes vitamin D from sunlight on your skin. In the UK there is not enough sunshine in autumn or winter to make all the vitamin D that we need.

Consider taking a vitamin D supplement daily in autumn and winter.

Vitamin D is in oily fish, red meat, offal, and egg yolks. Some breakfast cereals, margarines and non-dairy milk alternatives have vitamin D added.

Protein

You need protein for growth and repair, and to keep you strong.

Some lactose free milks have more protein than others. Lactose free cow’s milk and soya milk contain the most protein; oat and nut milks contain the least protein.

Eat 2 - 3 portions of high protein foods daily.

Non-dairy sources of protein include meat, fish, eggs, beans/pulses, tofu and nuts.

Meal ideas

Breakfast

• Cereal with lactose free milk
• Toast with dairy free spread and jam

Lunch

• Sandwich with dairy free spread and tuna/ ham/ chicken/hard cheese and salad
• Homemade soup made without milk or cream
• Jacket potato with dairy free spread, tuna/baked beans/hard cheese and salad
• Eggs or baked beans on toast with dairy free spread

Evening meal

• Meat/chicken/fish with potatoes or rice and vegetables
• Omelette/frittata with side salad
• Spaghetti Bolognese
• Curry made without yoghurt, with rice and dahl

Snacks

• Fruit
• Nuts
• Crisps (not cheese and onion)
• Oat cakes/ rice cakes/ crackers with dairy-free spread
• Tea, coffee, squash, lactose free milk
• Dark chocolate
• Biscuits

Lactase enzymes

You can buy lactase enzymes from pharmacies, health food shops and online. They may reduce your symptoms if you do eat lactose by replacing the lactase that your gut does not make. There is not much research on how well they work.

Can I ever eat foods containing lactose?

Most people find that their symptoms get better after cutting out lactose for 4 weeks. If you have secondary lactose intolerance, it can take longer.

Once your symptoms get better, try to put some lactose back into your diet. Start with a very small amount and increase slowly. Most people can manage some lactose but everyone has a different limit.

• You should start by trying foods that are lower in lactose such as hard cheese.
• Try a small amount and increase it gradually until you find the level you can manage.
• Then you can try foods that are higher in lactose, like milk.
• Start with a splash of milk in your tea/coffee or on your cereal and build it up slowly.
• When you start to get symptoms, you have found your limit.

What if symptoms don’t improve?

If you are lactose intolerant then your symptoms should get better when you take lactose out of your diet.

If you do not feel better, then you do not have lactose intolerance and you can start having lactose again. You can talk to your doctor or dietitian about what else could help your symptoms.

Risk of anaphylaxis (serious allergic reaction) when reintroducing lactose

If you have ‘atopy’ (eczema, asthma, other allergies, hay fever), there is a very small risk that you can develop an allergy to milk protein if you completely avoid it for a long time.

To avoid this risk you should try to keep some low lactose dairy products in your diet such as hard cheese.

This page will provide you with information about longer term feeding tubes. The page will tell you what to expect before, during and after your operation. 

A member of the medical team, your dietitian or your speech and language therapist can answer any further questions you may have.

What is a feeding tube?

A feeding tube is a small tube that passes through the skin into your stomach. This allows special liquid feed, water and medicines to be passed into the stomach. It can help to meet your dietary needs.

The three different operations used in North Bristol Trust are:

• Percutaneous Endoscopic Gastrostomy (PEG) – uses a flexible camera (endoscope) that passes into your stomach.
• Per-oral Image Guided Gastrostomy (PIGG) – the tube is placed using x-ray.
• Radiologically Inserted Gastrostomy (RIG) – the tube is placed using x-ray.

The most common tube is the PEG. You may have a RIG or PIGG tube if you cannot have sedation or if the camera cannot access your stomach.  We will discuss with you which type is best. 

Why do I need a feeding tube?

There are many reasons why you may need a feeding tube. We will discuss this fully with you. You may consider a feeding tube when:

• You are losing weight.
• You cannot eat or drink enough.
• Eating and drinking leads to choking or discomfort.
• Your breathing function is reduced or you get chest infections.
• It takes a long time to eat and it is no longer enjoyable for you.
• You have been getting nutrition through a tube in your nose for many weeks (nasogastric tube (NG)).
• The feeding tube in your nose keeps coming out.
• It is unsafe for you to eat or drink.

Sometimes feeding tubes are placed if you have problems with swallowing.

Will a feeding tube stop me eating and drinking?

What are my other choices if I decide against having one?

How do I prepare for a feeding tube?

Are there any risks?

How is the tube placed?

If you are having a PEG

This is done in the Endoscopy Department. You will be given a local anaesthetic to your stomach, some throat spray, and light sedation (to make you feel relaxed). An endoscope (a flexible tube with a light and camera at one end) is passed down into your stomach and lit up.

A small cut is made in your stomach where the light shines and the tube is then passed through. The operation usually takes around 20 minutes.

You will be in the unit for some time before and after the operation.

This is what a PEG tube looks like: 

If you are having a PIGG

This is done in the Interventional Radiology Department. A narrow tube is passed through your nose into your stomach. Air will be passed into your stomach through the tube to make it visible on X-ray.

Local anaesthetic will numb your stomach. A small cut is made in your stomach and a wire is passed through to your mouth. The feeding tube is then passed through.

This operation typically takes 30 minutes.

This is what a PIGG tube looks like:

If you are having a RIG

This is done in the Interventional Radiology Department. A narrow tube is passed through your nose into your stomach. Air will be passed into your stomach through the tube to make it visible on X-ray.

Local anaesthetic will numb your stomach and stitches are placed to hold the stomach close to the wall of the abdomen. A small cut is made near the stitches and a feeding tube is passed through into the stomach.

This operation typically takes 30 minutes.

This is what a RIG tube looks like:

What happens afterwards?

If there is:

• Leaking of fluid around the tube.
• Pain on feeding.
• Prolonged or severe pain after the operation.
• New bleeding. 

Stop feed immediately

Phone your community feeding team or visit your local accident and emergency department for urgent advice

How do I look after my feeding tube? 

PEG / PIGG

RIG

What help is available once I leave hospital?

Your ward dietitian will refer you to the community feeding team or an alternative service in your area. The community feeding team are known as the home management services (HMS).

The team comprises of dietitians, home enteral feeding nurses and a delivery company. They will contact you to arrange a monthly delivery of feeds and plastic equipment, such as syringes.

We may send you home from hospital with a small supply of feeds and equipment.

Your ward dietitian will explain your home feeding plan and provide contact details for the HMS team. Your GP may also be involved in the management of your tube.

What do I do if the tube becomes blocked?

How long will I need the tube?

What if the tube is accidentally removed? 
 

For PEG/PIGG tube

For RIG tube

Common questions

Further information

Nutricia website provides information on specialist feed and using a feeding pump. There is also information on the nursing team who help people with feeding tubes: 

• Nutricia Flocare - Infinity Training
• Nutricia UK | Homepage for Patients & Carers

PINNT helps people on enteral and parenteral nutrition providing advice and local help groups.

• Phone 020 3004 619
• PINNT: Advocacy & support for people on home artificial nutrition (HAN): parenteral, enteral & oral nutritional supplements. | PINNT

References

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT002346. 

Forms, Booklets and Leaflets

You can get physical copies of these booklets and leaflets from the Macmillan Wellbeing Centre based at Southmead Hospital. Please come and visit.

Referral Forms:

Self-referral form

Professional referral form 

Eating well:

Healthy Eating and Cancer – Macmillan Healthy eating and cancer

Healthy Eating – British Dietetic Association Healthy eating 

Healthy Snacks – British Dietetic Association Healthy snacks

Difficulty with eating:

Eating Problems and Cancer – Macmillan Eating problems and cancer

Building Up Diet – Macmillan The build up diet

Weight management after cancer treatment:

Managing Weight Gain After Cancer Treatment – Macmillan  Managing weight gain

Weight loss - British Dietetic Association  Weight loss advice

Portion sizes - British Dietetic Association Portion sizes

Has the sample I sent recently arrived in the lab yet? How can I check?

Why has the sample I collected been rejected?

When will the results be available

When does the failsafe get updated?

Who do I contact for advice?

Can I arrange a visit to the laboratory?

Will the test show if a baby is a Cystic Fibrosis (CF) carrier?

Will the test show if a baby is a sickle cell carrier?

Will the test show if a baby has thalassaemia?

When did the Bristol Newborn Screening Laboratory start testing babies in the South West for each of the nine conditions?

North Bristol NHS Trust is committed to making reasonable adjustments to support patients and carers whilst they are in hospital and to work in partnership with them.

Carer contributions are greatly valued. To help you to give ongoing support and care to your loved one whilst they are in hospital we have a Carers Support Scheme. The Scheme provides complimentary parking, an access card to the staff restaurant and referral to our Carers Liaison Service.

Complimentary parking and restaurant access card

Eligibility

The carer spends a minimum of three hours per day or the equivalent of 20 hours or more over a seven day period on the ward providing support to the patient.

This support could include:

• Personal care - providing assistance with washing/dressing.
• Oral hygiene/mouthcare - teeth brushing/cleaning dentures.
• Assisting with eating and drinking.
• Providing support at the end of life.
• Helping to reduce patient anxiety or behaviour which indicates that the patient is anxious or distressed.
• Providing reassurance to the patient when difficult or painful procedures need to be performed, including accompanying the patient to the theatre and being present in recovery after the operation.
• Providing assistance if the patient is uncooperative, for example if physiotherapy is considered to be necessary to aid the patient’s recovery.
• Helping to prevent the patient falling.
• Providing other forms of support as agreed between the carer/parents/ward staff or registered practitioner.

Carers who are eligible can receive:

• Complimentary car parking for up to two weeks (this can be renewed when requested by staff).
• Access to the staff restaurant for meals.
• Support to stay overnight which, depending on availability, may be a reclining chair or bed.
• Referral to the Carers Liaison Support Service.

Senior members of staff should be consulted when applying for a carer to access a car parking permit or restaurant access card, but any member of staff can support a carer to complete the form.

Carers will be given an information leaflet about the Carers Support Scheme to read to make them aware of the terms and their accountability under the agreement.

Complimentary parking

• A complimentary car parking permit is valid for all public car parks on the Southmead Hospital Site.
• Carers must visit the Security and Parking office to collect their permit where their car registration will be added to the system. Car park barriers will open and a parking ticket will be issued for use in the pay and display car parks.
• The car parking permit is valid for up to two weeks. Permits can be renewed multiple times up to the end of a hospital stay. Ward staff will need to complete a new form each time it is renewed.

Please note that two carers’ registration numbers will be allocated to one permit/per patient.

If you wish to exchange a registration number for another please take the slip issued by the Security and Parking Office who will then update your details. If circumstances change you will not automatically be guaranteed a new permit.

Important information for Blue Badge holders

This badge can only be used by the named badge holder, or by a person who has dropped off or is collecting the badge holder from the place where the vehicle is parked. It is a criminal offence for anyone else to use this badge in any other circumstances.

Access to the staff restaurant

Carers Cards

• Carers can obtain a Carers Card from the Security and Parking office. A £5 deposit is required and will be fully refunded when the card is returned.
• The Carers Card will allow access to the staff restaurant (you will be given a separate map when you pick up the card) to purchase a hot meal and drink at advertised prices. Meals and drinks are not discounted or free; cards only provide access to the Vu restaurant.
• To use the card, hold it up near the grey boxes at the side of the door. There should be a beep and the light will change to green. You can now open the door. Try again if you get multiple beeps or a red light.
• Carers Cards are valid for up to two weeks and can be renewed multiple times up to the end of the hospital stay. The ward will need to complete a new form each time it is renewed.
• All Carers Cards must be returned to the Security and Parking Office upon discharge where the £5 deposit will be fully refunded.
• All Carers Cards will be cancelled after seven days if not being used.

Please note the Security and Parking Office is open 7am – 6.30pm, Monday to Friday. If a patient’s expected discharge date is outside of office hours please return the card before the office closes at 6.30pm explaining the situation.

Card usage rules

• Cards do not provide access to any wards.
• Access to the staff restaurant from the Atrium is through one specified door (see map).
• Only one card will be issued per patient (cards can be shared if more than one person is providing care that fits the eligibility above).
• Only two carers are permitted per restaurant visit (if sharing cards as above).
• Patients are not permitted in the staff restaurant.
• Cards must not be passed to other hospital visitors; it is only valid for the carer it is issued to and must not be kept on the wards.
• Meals are not discounted or free - cards only allow access to the restaurant.
• If you are found to have abused any of the above, cards will be withdrawn.
• Cards must be returned to the Security and Parking Office at the end of hospital stay when the £5 deposit will be refunded.

Cards can be withdrawn should the criteria not be fully adhered to.

If you have any questions or concerns regarding the Carers Support Scheme, please speak to staff on the ward or at the Security and Parking Office.

Carer Support Services

There are a number of different carer support organisations across the country who can provide information, support and signposting for unpaid carers. These organisations can make sure you are linked into services providing financial, practical and emotional support for your role.

To find your local carers support service contact your county council or go to the Carers Trust website at https://carers.org/ and use the search feature to find your local centre.

Support for Carers in Bristol and South Gloucestershire

Carer liaison workers are based at Southmead hospital. We work with carers supporting someone living in Bristol and South Gloucestershire.

We can:

• Provide help, information, and advice to carers through their hospital journey as a carer and/or patient, working directly on wards and signposting to other services for support.
• Refer carers for ongoing community support upon discharge.
• Provide information on services available to carers within the hospital and the wider community.
• Liaise between the discharge team, ward staff and carers and their family, to help with any concerns or worries.

How to contact us 

Telephone: 07557 418692

Email: carersliaison@nbt.nhs.uk

© North Bristol NHS Trust. This edition published February 2023. Review due February 2026. NBT003195

Appetite and health

Having a good appetite is important to make sure your body gets all the nutrients it needs to stay healthy.

As you get older or become unwell, your appetite can disappear.

This page offers tips to help you eat better.

Some of the information may be different to typical ‘healthy eating’. However, when you are ill healthy eating may be harmful for your health.

Once you are well or a healthy weight you can return to healthy eating.

Possible side effects of having a small appetite

• Higher risk of infection
• Higher risk of falls
• Lower mood
• Lower energy levels
• Loss of muscle and reduced strength
• Nutrient deficiencies
• Hospital treatment may be less effective
• More hospital admissions and longer hospital stays

Tips for eating better with a small appetite

• Eat ‘little and often’.
• Have 2-3 small snacks or milky drinks in between meals.
• Try not to skip meals. Skipping meals often can cause low appetite.
• Choose full fat/full sugar versions of food/drink rather than the ‘diet’ alternatives.
• Try to eat more on the days and times you feel well.
• Aim to have 1 pint of milk a day. This can be in tea, coffee or milkshakes.
• If following a plant based diet, try and include alternative milky drinks and puddings (e.g soya, oat milks etc).
• Have a pudding after meals.
• Eat in a peaceful environment. You may find turning on the TV or eating with friends and family helpful.
• If cooking/shopping is too much, consider meals on wheels e.g. Wiltshire Farm Foods, Oakhouse or Cook.
• If you have access to the internet you may also find home delivery helpful. Age UK and Red Cross can help with shopping.

Which foods should I snack on?

Foods with lots of energy and protein are a good source of fuel. They also help fight infection.

High protein foods include:

• Meat, fish, poultry
• Cheese, milk, eggs
• Tofu, beans, lentils
• Yoghurt, cream and milky puddings
• Nuts and seeds
• Milky drinks e.g. hot chocolate, ovaltine
• Fortified drinks and food
• If on a plant based diet - dairy free milks and puddings

High energy foods include:

• Biscuits
• Crisps
• Cakes
• Chocolate
• Puddings
• Cream
• Butter
• Fruit juice and smoothies

Choose full-fat versions of these foods whilst you are unwell.

Snack ideas

Aim for 2-3 snacks every day.

Savoury

• “Cream of” soups - have 1 x tin or 1/2 tin with croutons
• Handful of Bombay mix or nuts
• Matchbox size portion of cheese and crackers
• 1x bag of crisps
• Slice of quiche
• 3 x cocktail sausages
• 2 x mini sausage rolls
• 1 x small pork pie
• 1 x slice of toast with butter
• 1 x crumpet or bagel with butter

Sweet

• 1 x slice toast with butter and jam/marmite/peanut butter/chocolate spread
• Scone with jam and cream
• Rice pudding
• Cereal bar
• 1 x tea cake
• 1 x slice malt loaf
• Individual puddings e.g. trifle, custard, cheesecake, mousse
• 1 x bar of chocolate
• Full fat yoghurt
• 1 x handful of dried fruit
• 1-2 x scoop of ice cream

Nourishing drinks

If you struggle to have extra snacks try to have 1-2 nourishing drinks instead.

Aim to have 1 pint of milk a day. Use in cereal, tea, coffee and other nourishing drinks listed below.

• Full cream milk (aim for 1 pint per day)
• Milkshakes
• Hot chocolate
• Malted drinks
• Milky coffee and tea
• Smoothies
• Sugary fizzy drinks e.g. lucozade, cola
• Fruit juice
• Soya drinks e.g. Provamel, Alpro Soya

Fortifying foods

This can be helpful to make food more nourishing, without having to eat a larger portion.

Fortified milk

• Whisk 4 heaped tablespoons of milk powder (e.g. Marvel or supermarket own brand) into 1 pint full fat milk.
• Use this fortified milk in cereal, porridge, milky drinks, tea/coffee, puddings, soups and sauces.

Fortified mashed potato

• Add 1 x heaped tablespoon of butter and 1 x tablespoon of cheese to a scoop of mashed potato.
• Use fortified milk.

Fortified yoghurt/custard/milk pudding

• Add 1 x heaped tablespoon of milk powder to one serving of yoghurt/custard/milk pudding.
• Add toppings such as jam, syrup, honey, seeds or fruit.

Fortified sandwiches

• Use spreads (e.g butter/margarine) generously.
• Use lots of mayonnaise or salad cream.
• Choose nutritious fillings such as peanut butter, egg mayonnaise, ham, tuna or cheese.

Fortified soups

• Add cream, fortified milk, evaporated milk, creme fraiche, cheese or cooked meat.
• Have croutons or bread.
• Choose creamy varieties e.g. cream of tomato.
• If using cuppa soups, make with fortified milk.

Fortified sauces

• Use enriched milk to make white, cheese or packet sauces.
• Add meat juice to gravy.
• Add grated cheese, oil or 1 x teaspoon milk powder to one serving of tomato based sauces.

Fortified vegetables and salads

• Try frying or roasting vegetables instead of boiling/steaming.
• Add butter or grated cheese to vegetables.
• Have cheesy or creamy sauces with vegetables.
• Add cheese, nuts, eggs, beans, tofu or lentils to salads.
• Use generous helpings of oil/creamy dressing and croutons/potatoes.

What about diabetes?

If you have diabetes and a poor appetite it may not be helpful to follow the usual ‘low fat, low sugar’ healthy eating advice.

However, once your appetite has returned to normal, you can return to healthy eating.

Meal ideas

Breakfast

• Creamy scrambled egg with buttered toast
• Porridge/cereals with honey/sugar
• Crumpets with butter and jam
• Muesli with whole cream milk and natural yoghurt

Lunch/lighter meals

• Beans on buttered toast with grated cheese topping
• A buttered jacket potato with tuna mayonnaise filling.
• Ham or cheese omelette, chips and salad with mayonnaise
• A creamy soup with added grated cheese and croutons

Main meals

• Shepherd’s pie with grated cheese topping and vegetables with added margarine or butter
• Chicken curry or dahl with rice or chapatti spread with oil, butter or margarine
• Cauliflower cheese made with fortified milk with grated cheese topping
• Fish in cheese sauce with creamed potatoes and vegetables with added margarine or butter

Puddings

• Milk pudding e.g. rice/tapioca/semolina
• Baked egg custard
• Crumble with ice cream
• Trifle with cream
• Jelly made with fortified milk

Nutritional supplements

Some people may be prescribed nutritional supplements from their doctor or dietitian.

Supplements are drinks that are high in energy and protein and can be helpful for some people whilst unwell. They are available on prescription. Your doctor or dietitian will discuss these with you if they think you may need them.

You can buy other supplements such as Complan or Meritene from local chemists. You may find these helpful if you cannot make nourishing drinks at home.

Where now?

For further information you may find the following resources useful.

Brotherton et.al (2010). ‘Malnutrition Matters: Meeting Quality Standards in nutritional Care.’ A report on behalf of the BAPEN Quality Group

Diabetes UK

www.diabetes.org.uk

Cook Food - freezer meals with delivery service

www.cookfood.net

Parsleybox - cupboard meals with delivery service

www.parsleybox.com

Wiltshire Farm Foods

www.wiltshirefarmfoods.com

Oakhouse Foods

www.oakhousefoods.co.uk

Eating well in later life - Malnutrition Task Force

www.malnutritiontaskforce.org.uk/eating-well

Food enrichment - BAPEN

www.bapen.org.uk/nutrition-support/nutrition-by-mouth/food-first-food-enrichment

Malnutrition fact sheet - British Dietetic Association

www.bda.uk.com/resourceDetail/printPdf/?resource=malnutrition

The Red Cross - offering help with shopping

www.redcross.org.uk

AgeUK - offering help with shopping

www.ageuk.org.uk

How to contact us 

Dietetic Department: 0117 414 5248

© North Bristol NHS Trust. This edition published April 2023. Review due April 2026. NBT002833

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

If you’re an overseas visitor, you may need to pay for your treatment or you could face fraud or bribery
charges, so please contact the overseas office: Tel: 0117 414 3764 Email: overseas.patients@nbt.nhs.uk

Information for GP's

The implementation of the Faecal Immunochemical Test (qFIT) testing for occult blood for the detection of colorectal cancer in patients in the SWAG cancer alliance area

Individual CCGs (Gloucester, BNSSG, BSW and Somerset) within the SWAG Cancer Alliance have funded FIT testing for the early detection of colorectal cancer.  Originally this was for low risk patients but indications have been expanded and updated. 

For further information on the requesting indications, process and reporting guidelines please refer to the relevant page on the REMEDY website: https://remedy.bnssg.icb.nhs.uk/adults/gastroenterology-and-colorectal-surgery/fit-test/

Information about qFIT testing is presented in this video made when the service was first introduced. Although some of the indications have been expanded the essence of the video is still applicable https://youtu.be/zb1o8ykvS6U

The team comprises clinical scientists and trainees who work closely with urology, gynaecology, consultants, physiotherapists and dietitians, enabling a holistic service.

As well as performing diagnostic tests the team also attends MDTs, conducts research and provides teaching to other healthcare professionals.

Rachel Tindle
Clinical Scientist/Lead Clinical Scientist for NBT

Amie Sutton
Trainee Clinical Scientist

Sarah Massa
Clinic Co-ordinator

Alex Bacon
Clinical Scientist

Laura Thomas
Department manager/Clinical Scientist

We are pleased to be able to offer this free online training course via Microsoft Teams.  

The course is a full day and consists of both theory and practical exercises outlining models, tools and access considerations for AAC Assessment and implementation for people with Adult neurological conditions.

We will ask those attending to bring a case study with them to share and relate their learning to. A template for case studies will be sent out to attendees a week before the course date. There will be opportunities to ask any specific questions you have and learn more about the service AAC WEST offer.

Available dates:
Tuesday 13th May 2025 at 9:00am- Book here with Eventbrite

We are pleased to be able to offer this free online training course via Microsoft Teams.

The course is a full day. We will cover tools for setting and evaluating goals, choosing appropriate vocabulary sets and several strategies for AAC implementation including resources.

The focus will be mostly practical and appropriate for therapists and assistants. It will be applicable for those supporting paediatric and ALD caseloads who are mainly symbol users.

We will ask those attending to bring with them a case study to share and relate their learning to. A template for case studies will be sent out to attendees a week before the course date. There will be opportunities to ask any specific questions and have discussions in small groups.

Available dates:

Wednesday 8th May 2024 - Book here with Eventbrite

Wednesday 27th November 2024 - Book here with Eventbrite