Ensuring good nutrition while following a special diet on the critical care wards

Why is nutrition important on Critical Care?

Ensuring a good energy and protein intake while you are really unwell, or recovering from a critical illness is very important. You can lose strength and muscle mass whilst you are unwell, particularly if you are deeply sedated as part of your treatment. Ensuring good nutrition can help to reduce muscle mass loss and support rehabilitation afterwards. It can be harder than usual to follow a special diet on the critical care wards, particularly if you are being fed via a nasal tube feed or intravenous nutrition. However, there may be ways that we can help to support you with this.

Please let the bedside nurse or the ward dietitian know if you (or your partner, family member or friend) has any dietary requirements or food allergies (such as vegetarian, kosher, halal, wheat-free, dairy-free or vegan diet)

The ward dietitians work Monday to Friday 09:00 to 17:00. If you are a patient and have questions, or if you are visiting your partner/family member/friend during this time and would like to speak with the ward dietitian, then please ask your bedside nurse to contact them. If they are not available to meet with you then a time can be arranged for a conversation or phone call.

When you are eating and drinking

Vegetarian, wheat-free, dairy-free, food allergies or strong food preferences

All meals are coded for vegetarian, wheat-free, dairy-free on the back of the critical care meals menu. There are coloured dots which indicate if the meal is suitable for your diet. The housekeeper on the ward can provide information on the main food allergens in all hospital meals. If you do not like many of the options available or, you have multiple food intolerances or allergies, then please ask your dietitian or housekeeper for the special diet order booklet. Meals from here need to be ordered 24 hours in advance.

Wheat and gluten-free bread, sandwiches and breakfast cereals can be ordered from the kitchen. Toaster bags to ensure there is no contamination of the wheat and gluten-free bread in the toaster are also available.

Vegan, Kosher or Halal diets

There are separate menus for these, please ask the ward housekeeper for a copy. However, there may also be items that you can order in addition to the main ward menu from the special diet booklet. Please speak with your dietitian or housekeeper to see this and order extra items and snacks.

Soya milk, rice milk and soya desserts can be ordered from the main hospital kitchen by the ward housekeeper. Soya milk has a better calorie and protein provision than rice milk. If you require a dairy alternative product and can tolerate soya products, soya milk would be recommended.

For all dietary requirements

When you don’t feel well, it can be hard to meet your full nutritional requirements from meals alone. Family or friends can bring in snacks or extra meals for you if you would like. Items can only be kept in the fridge on the ward for three days and need to be clearly labelled with your name and the date they were first stored. If food needs to be reheated, it must be agreed with a senior nurse and you will be asked to sign a disclaimer.

When you are not hungry it can be easier to take drinks than food. Nourishing drinks can be an easy way to top up your energy and protein intake.

Cow’s milk and milk-based drinks such as hot chocolate or Ovaltine are always available from the ward kitchen (as well as snacks like yoghurts, ice cream and custard pots).

Nutritional supplement drinks can be given if you are not managing to eat much of your meals. These are often an easy way to boost your energy and protein intake, as each bottle contains 300kcal and 8-18g protein (depending on which one). You can request them from your nurse or housekeeper at any time. Your dietitian may advise you to try to have a certain number of these supplements each day.

In each type of nutritional supplement there are vegetarian options (such as vanilla, chocolate, banana, orange, lemon, mocha etc.). Some other flavours however, contain carminic acid from insects. These include: strawberry, apricot, peach/mango, berries and forest fruit flavours. Fortisip Plant Based is a vegan supplement and comes in the flavours mango and passion fruit and mocha.

All nutritional supplements (such as Fortisip Compact Protein, Fortijuce) are wheat-free and kosher (except the flavours that contain carminic acid). Most supplements are halal excluding Forticreme, Calogen, Scandishake and Nutilis. These products do not contain any forbidden ingredients but the manufacturing process has not been observed by the relevant body so have not been certified.

The standard supplements available on the ward all contain milk proteins. Fortijuce and Fortisip Compact Protein are very low in lactose and suitable on a lactose free diet. If you require a dairy-free supplement then please speak with your dietitian. Fortisip Plant Based is a milk protein free alternative.

When you are being tube fed

Wheat free, Kosher, nut & egg allergies – all of the Nutricia tube feeds are suitable for these dietary preferences.

The enzyme which is used to break down the proteins in the Nestle Peptamen HN Nutrison Peptisorb and Nutrison Peptisorb Plus HEHP feeds is not halal. This enzyme has been added to make them easier to digest, which is important in certain conditions. These feeds have however been certified as kosher. Other feeds that we regularly use are certified halal.

Vegetarian, dairy free, Vegan – Most Nutricia feeds contain both fish oil and milk protein. Nutrison Petisob, Nutrison Peptisorb Plus HEHP, Nutrison Soya and Nutrison Protein Advance are all fish oil free and suitable for vegetarians. All Nutricia and Nestle tube feeds are clinically lactose free apart from Nutrison Peptisorb and Nutrison Peptisorb Plus HEHP.

All tube feeds (enteral feeds) contain a vitamin D sourced from sheep wool of healthy living sheep so are not considered full vegan. However in some circumstances Fortisip Plant Based supplement could be given via a nasal tube.

The partially digested feeds are made from milk proteins (feeds such as Nutrison Peptisorb, Nutrison Peptisorb Plus HEHP and Nestle Peptamen HN). When they have been partially digested the milk proteins have been broken down. These feeds are then suitable for nearly all those with milk allergies.

Prosource TF ENFIT and Nutrison Protein Shot protein supplements are not suitable for vegetarians. Prosource TF ENFIT are made from kosher ingredients but the manufacturing process has not been observed by the relevant body so they have not been certified. Nutrison Protein Shot also contains milk proteins, is halal but is not certified kosher. Prosource TF Plant is a vegan protein supplement that is allergen free and made with pea protein.

If there is a special reason that you would benefit from a feed that would not meet your (or your partner, family member or friend’s) stated dietary preferences, then the ward dietitian will come to discuss it with you in more detail.

When you are on intravenous (parenteral) nutrition

The intravenous (parenteral) nutrition we use on critical care contains egg-based protein and fish-oil. There is a fish oil free alternative but there is no parenteral nutrition available in the hospital which is egg free.

It is likely that you are only started on parenteral nutrition because it is not possible to feed you into the gut. If an egg-containing PN is not suitable we may struggle to find any alternative. Your dietitian will come to discuss this with you in more detail if there are any concerns about this.

How do I contact my healthcare professional if I have any questions?

Name and role:

Contact number: 01223 216655