Dietetics - Eating well with Fatigue

Fatigue

Fatigue is extreme tiredness or lack of energy that doesn’t improve with rest and affects daily activities. Fatigue can make tasks such as eating and cooking feel overwhelming.

Although it is not a cure, nutrition plays a role in managing fatigue and supporting overall wellbeing. This leaflet offers practical tips on how to eat well with fatigue.

Why is it difficult to eat well with fatigue

You may go through each of the steps below for you to reach the point where you are eating a meal. Each step uses up energy and so it is not surprising that it can feel impossible to make a balanced meal some days, or that you are too tired to eat it once you have cooked.

Steps to eating a meal:

Step 1: Make a plan of what meals and snacks to have
Step 2: Go shopping for the food
Step 3: Prepare and cook the food
Step 4: Sit and eat the meal
Step 5: Wash up and clean down the kitchen

Repeat steps 3-5, three or more x day

A balanced diet

You should aim to eat foods from each food group over a day/ week to ensure you are eating a range of nutrients.

This includes:

• Fruit and veg
• Starchy carbohydrates e.g. bread, rice, pasta
• Protein e.g. meat, chicken, fish, soya protein, beans etc
• Dairy/dairy alternatives e.g. milk, soya milk, cheese
• Small amounts of fats e.g. oils, spreads

Aim for a regular meal pattern - avoid not eating for long periods then having a big meal at nighttime. Having a regular meal pattern can help control circadian rhythm (the body’s internal clock), which in turn can support sleep. Think 3-4 small meals at similar times each day. Where possible, have higher fibre sources of carbohydrate to help give you a slow release of energy rather than a quicker, short-lived boost:

• Brown rice and pasta, or consider white versions mixed with kidney beans/chickpeas/lentils to increase fibre
• Wholegrain or seeded breads
• Potatoes with skins on
• Cereals such as oats, Weetabix, shredded wheat and muesli
• Oat cakes, seeded crackers

Hydration

Dehydration can worsen tiredness so it’s important to ensure you are drinking enough

• Always keep a water bottle/flask with you
• Aim for 1.6-2L per day of fluids such as water, cordial or flavoured water. Coffee and tea also count but ensure that caffeinated drinks aren’t your only source
• Caffeinated drinks such as tea, coffee, energy drinks and some soft drinks may be poorly tolerated by those with fatigue conditions and so it is best to reduce or avoid these altogether. If taken late in the day it can affect sleep, so decaffeinated tea and coffee can be useful. Even if caffeine is well tolerated the maximum recommended intake is 400mg caffeine per day.

Caffeine in common drinks:

Coffee 60-120mg Tea 40-50mg
Coke 30-40mg
Energy drinks 72-160mg
Hot chocolate 5-15mg

Supplements

There is not enough evidence to recommend specific supplements to reduce fatigue. However, if you have a very small intake and/or minimal fruit and vegetable, you may want to take a multivitamin to prevent deficiency.

It is recommended for all that we take a 10 microgram Vitamin D supplements from October to March in the UK. You may need to take this year round if you are not often outdoors, wear clothes that cover most skin when outdoors or you have dark skin.

If you take a multivitamin this may already include vitamin D. The maximum daily dose for vitamin D you should not exceed is 100 micrograms/4000IU.

Quick tips

• Consider eating the same 1-2 breakfasts every day so you don’t need to make decisions
• Use readymade meal plans to take the work out of thinking what to make, you can always tweak the odd meal that is not to your liking or needs. Try major supermarket websites for healthy balanced meal plans
• Use short cuts – pre chopped vegetables, readymade salads, frozen fruit and veg, precooked packets of rice/grains, precooked meat etc
• Keep ready meals you like in the fridge or freezer for when you need a no prep day. You can always add some more frozen veg for more fibre, or a piece of wholegrain bread to make it more filling
• Click and collect or supermarket delivery may save energy and allow you to avoid a busy environment. You can also have a shopping list saved online so you don’t have to keep recalling what to buy each week
• Batch cook, especially if you have friends or family to help with this. Cook main meals and portion out, or you can prepare ingredients to reduce work over the week (pre chop veg/salad, boil eggs, roast a whole chicken, make a batch of pasta)
• There are many online meal prep delivery services if you need convenience, and it is within your budget
• Sit while you prep food if you are able

Useful equipment:

Items you may wish to think about to support kitchen prep, cooking and drinking:

• Perching stool
• Kettle tipper/stand
• Box choppers to cut whole veg in one go
• Flasks/water bottles

If you are struggling around the home, you could ask your GP for an occupational therapy assessment. Occupational therapists may be able to provide some equipment to support independence.

Quick meal options

Here are some quick or low prep meal ideas to reduce time in the kitchen so you have more energy for eating:

• Porridge pots/cereal with milk, option to add fruit
• Tinned/carton soup with bread (ideally a soup with a protein source such as chicken, lentils, beans, or add cheese to your bread)
• Eggs/baked beans/cheese on toast
• Sandwich/wrap/bagel with ham/precooked chicken/peanut butter/cheese/pre drained tuna and salad leaves. A yoghurt on the side
• Ready to eat tuna pasta/cous cous pots
• Dried noodle/pasta pots – add frozen veg, cooked chicken/tofu/ chickpeas
• Ready meals: look for options to suit you such as high protein, eat well, fresher options from the fridge section
• Cook a stir-fry veg bag, add pieces of cooked sliced beef, a sauce of choice, option of packet rice
• Freezer options for oven/air fryer – fish fingers, fishcakes, veggies sausages, add a potato option and frozen peas
• Veggie/beef meatballs, add to a wrap with humous and salad
• Omelette, start with quick cook veg like spinach and spring onion or sweetcorn, add eggs and top with grated cheese/feta. Option for side salad or bread
• Meals in a tin e.g. curry, chilli, beef casserole. Option to add some packet rice
• Snack plate options: feta/cheese, olives, sundried tomatoes, bread/flatbread, humous, salsa, crackers, cooked meat, premade Spanish omelette or quiche, falafel, cucumber, carrots, salad leaves, pickles
• Heat stock, add flavours you like e.g. Thai curry paste, soy sauce, sesame oil, lime, miso, coconut milk. Once brought to the boil add gyoza/dumplings until cooked. Pour everything over chopped spring onions/carrots/spinach
• Heat a vegetable broth style soup, add tortellini until cooked
• While steaming some broccoli for a few minutes, add to a dish: leftover chopped chicken, feta, sundried tomatoes, spinach/ rocket, and toasted nuts. Drain and roughly chop the broccoli, add to the dish. Season and add extra dressing if you like
• Cooked frozen jacket potato, with topping such as egg/tuna and sweetcorn mayo, a tin of chilli, baked beans, cheese

Managing appetite changes

If you are struggling to maintain a healthy weight and losing weight, you may need to make the most of what you are eating with higher calorie options:

Add extras:

• Use full fat dairy foods
• Add peanut butter to porridge or spread on banana/dates
• Top pasta, toast, soups, potatoes and veg with grated cheese
• Veg oil spread to potatoes, vegetables and bread
• Add dips, pesto, humous and sauces with your meals
• Have breads as a side to main meals
• Use plenty of oil when cooking

Little and often approach

• Add snacks between meals or eat snack sized meals 4-5 x day if you are over faced by big meals. E.g. cheese and crackers, yoghurt and fruit, rice pudding, cereal and milk, half a sandwich, cereal bar, malt loaf with spread, flapjack

Desserts:

• You might find if fatigue is significant that soft foods are best, and there are lots of desserts that are easy to eat as well as high calorie
• Consider increasing the frequency you are eating these, cheesecake, rice pudding, trifle, cake, banana and custard, cream cakes, tiramisu, sponge and custard, ice cream

Nourishing drinks:

• Try swapping 1-2 of your usual drinks for a glass of warm or cold milk, Horlicks or hot chocolate made with milk, or milky coffee

Shopping list template

Below is a suggested shopping list that you can use as a prompt for easy foods to keep in from each of the food groups:

Fruit
☐    Low prep fruit; small pack grapes, apples, pears, berries, banana
☐    Tinned fruit in juice; peaches, pineapple, mixed fruits, pears, mandarins
☐    Frozen fruit; berries, mango, cherries
☐    Dried fruit (1 heaped tablespoon = 1 portion); sultanas, raisins, dried mango, prunes, dates
☐    Shorter shelf life but can be useful; fresh pre-chopped pots of fruit
☐    Fruit and jelly pots

Vegetables
☐    Low prep vegetables; spinach, salad leaves, baby tomatoes, mangetout
☐    Tinned veg; carrots, sweetcorn, tomatoes, green beans
☐    Frozen; peas, green beans, sweetcorn, chopped onions, chopped peppers, soya beans, parsnips, shredded cabbage, cauliflower/cauliflower cheese, butternut squash, sliced carrots
☐    Shorter shelf like but can be useful; pre diced root veg, sliced mushrooms, pre chopped onions, stir-fry veg bags
 
Protein
☐    Tinned chickpeas, taco beans, baked beans, lentils
☐    Pre chopped chicken pieces, marinated meat, mince
☐    Precooked chicken, ham, sliced beef
☐    Smoked salmon/poached salmon
☐    Tinned fish
☐    Frozen chicken goujons, fish, fish cakes
☐    Quorn/veggie sausages, mince, meatballs
☐    Eggs

Dairy
☐    Milk/alternatives with calcium added
☐    Yoghurts/yoghurt pouches
☐    Cream cheese, pre grated cheese (or individually wrapped portions)

Fats
☐    Oils
☐    Veg oil spread
☐    Nuts
☐    Peanut butter
☐    Vinegarette/salad dressing
 
Mixed meals
☐    Freezer section often have bagged meals that can be microwaved, (Paella, pasta, vegetable cous cous)
☐    Ready made
☐    Soups
☐    BOL pot/pasta pots
☐    Tinned curry, chilli or beef casserole, lentil bolognaise

Carbohydrates
☐    Rice/grain pouches
☐    Precooked noodles (short shelf life) or rice noodles that just require hot water until soft
☐    Cous cous/flavoured cous cous sachets
☐    Bread, wraps, pitta, bagels (keep in the freezer)
☐    Pouches of precooked risotto/pasta
☐    Frozen Gyoza/dumplings
☐    Fresh tortellini/ravioli
☐    Tinned potatoes
☐    Frozen chopped sweet potato/roast potatoes
☐    Readymade mashed potato
☐    Weetabix, muesli, oats/porridge pots
☐    Crackers, oat cakes, rice cakes
 
Extras
☐    Sauces, salsa, humous, pesto
☐    Biscuits, chocolate, crisps, cereal bars
☐    Desserts
☐    Milkshakes/protein milkshakes
☐    Horlicks/hot chocolate

When to ask for help

Please speak with your GP to refer you to appropriate services if you are struggling with the following:

• Sleeping so much that you cannot eat enough
• Struggling to swallow
• Losing weight/underweight, this may be noticed by friends and family, or your clothes may feel loose
• Often skipping meals
• Food restrictions/sensitivities that are leading you to cut out whole food groups

Additional resources

• BDA CFS/ME resource: Myalgic Encephalomyelitis (or Encephalopathy) / Chronic Fatigue Syndrome (ME/CFS)
• BDA food fact sheet: Long Covid and diet
• The ME Association
• Action for ME

Contact

Community dietitians
Email: Community.dietetics@nca.nhs.uk
Tel: 0161 206 2347