Professional Opinion

Professional Opinion: Are nutritional supplement drinks a good choice?

Celia Witt Beauchamp is a dietitian and diabetes educator at Coastal Carolina Hospital
Celia Witt Beauchamp is a dietitian and diabetes educator at Coastal Carolina Hospital Submitted photo

This week, Celia Witt Beauchamp, a dietitian and diabetes educator at Coastal Carolina Hospital, discusses the use of liquid nutritional supplements, particularly for older adults.

Question. Recently, the American Geriatrics Society cautioned against using liquid nutritional supplements, such as Ensure or Boost. Some have gone so far as to call these drinks "liquid candy bars with vitamins." Are these products safe or a good choice for seniors who need to keep weight on? What other options are there?

Answer. The recommendation you mention was part of the American Geriatrics Society's "Choosing Wisely" program, an initiative with the American Board of Internal Medicine to improve care for older adults. The society recently released a list titled "Five Things Physicians and Patients Should Question." This was the second such list the society has compiled.

The list did not completely nix Boost, Ensure and similar drinks for everyone. However, it cautioned against using them, saying that while they can increase weight in older people struggling with unintentional weight loss, they don't always help improve other important outcomes, such as quality of life, mood or survival.

In some cases, these commercial nutritional supplements are being marketed as a substitute for a healthy diet for busy adults. I believe that eating whole foods provide additional benefits. Here is why:

  • Whole foods contain nutrients that science may not have isolated yet. That's right. There may be nutrients in food that we are not aware of so we can't put them in a bottle. Highly processed foods contain only known and isolated nutrients in their recipe. In addition, they contain a variety of added sugars.
  • Whole foods contain soluble and insoluble fibers that may or may not be added to processed foods. Many older adults (and younger ones, too) complain of constipation. Eating whole foods provide both types of fiber that keep the GI tract (and the rest of you) healthy.
  • If you are drinking your meals you feel less full and are more likely to over-drink your calories. I include juicing your breakfast in this category. I also know a number of people whose breakfast drink is a prelude to a meal -- and not a meal substitute -- because it does not keep them full for long. According to the American Journal of Clinical Nutrition, McDonald's smoothies, for instance, average between 220 and 340 calories. Boost and Ensure contain between 240 and 360 calories per eight ounces. The main difference is the total amount/types of added sugar and the specific nutrients added to the commercial drinks.
  • Drinking your meal is not really part of the normal eating regime. Most of us will not take a meal replacement to a dinner party or expect our hosts to provide it. Learning to eat a healthy diet is part of a lifestyle to maintain a healthy weight.
  • Weight loss is complicated, and we try to make it simple when it is not. Controlling portions and cutting calories is the only way to lose weight and keep it off. Better options than liquid nutritional supplements include: portion control (get out your measuring cups), eating lower fat foods and increasing the complex carbohydrates (whole fruits and vegetables) in your diet.

    I do recommend Boost-, Ensure- or Carnation Breakfast Essentials-type drinks for people who are malnourished, those with certain types of cancer that impede oral intake and those in the hospital or who are very sick. I suggest we need to leave the nutritional supplement drinks for those who truly need to supplement their diet to meet their basic nutrition needs.

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