Nuts and seeds

Peanut butter

Avoid — On the avoid list of the leaflet this book follows, or restricted almost everywhere.

Peanut butter is the clearest case in this book of one leaflet being stricter than the rest, and of that strictness costing the reader something real.

Why it is restricted here

The leaflet this book follows puts nuts on the avoid list and does not carve out an exception for smooth nut butters. Peanut butter is a nut product, so it stays out of every recipe here.

Where hospitals differ

Almost everywhere else allows it. St George's, Oxford, Milton Keynes and Leeds all permit smooth peanut butter, and where crunchy versions appear they are classed as medium or avoid. The reasoning is that grinding has already done the work chewing cannot, and the result behaves like a fat rather than like a nut. Milton Keynes also lists it among the foods that help thicken a high-output stoma, so it is potentially doing two jobs.

Why it matters

Because it is one of the most energy-dense things you can put on white toast with no cooking at all. When appetite is poor and standing at a hob is hard, a food that needs only a knife is worth more than its calories alone suggest.

What to use instead

Lemon curd, seedless jam or a smooth chocolate spread with no nut pieces, all of which are allowed by the leaflet this book follows. None of them brings the protein, so pair them with fortified milk in a drink alongside. See fortifying.

What to do

Ask your team about smooth peanut butter first, ahead of anything else in the amber middle. See smooth peanut butter.

Swaps

Instead of Peanut butter, use Smooth chocolate spread, lemon curd or seedless jam: Peanut butter is a nut product and this diet excludes all nuts, so the same creamy sweetness comes from jam or lemon curd instead. Some hospitals allow smooth peanut butter, but the leaflet this book follows does not, so it stays off the ingredients list here.

Sources

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