Adding calories and protein: Oral Supplements or Food First?

I’ve finally decided it is time for me to speak out about the use of oral supplements (Ensure, Boost, etc.).   Oral supplements have been used for decades as a quick solution to adding calories and nutrients to the diet of older adults.  They are easy to consume and aren’t labor intensive.  They have many benefits and when folks are tired and aren’t meeting their calorie needs, many medical professionals jump to recommend them to their patients.

However, over the past few years I’ve begun to question why, during hospital care, we recommend these so quickly.  Why not recommend food first?  Would you rather drink an Ensure or have a fresh fruit and ice cream based milkshake?  How about cheese and crackers?  Or fresh fruit with yogurt?

Too many of us jump to oral supplements as a first line of defense when someone isn’t eating. There are several reasons for this:

  1. Cost.   The typical hospital will pay approximately 30-40 cents per can.  You can’t make a real ice cream based milk shake for that little.  So while your in the hospital, it makes sense that this will be given to you as a choice.  The cost on the “outside” isn’t so cheap.  Most consumers will pay $2.00 per 8 fluid ounces.
  2. Shelf Stable:  Oral supplements can sit on the shelf of a storeroom and won’t go bad like real food.
  3. Disbursement:  It is easier to leave a couple cans of a shelf-stable product next to your bed than it is to leave something that is ice cold that will begin to melt
  4. Standardization:  We know exactly what is in every can and we can count those calories and grams of protein so we know exactly what you are consuming.

Of course, all of these make sense and are good reasons….but I’d like to challenge our profession to go back to food first. Would we better serve our patients if we went back to the basics and thought about whole food calorie enhancements (like peanut butter, dried fruits, ice cream, cheese, nuts, fresh fruit, creamed vegetables, etc.)?  Could we save our patient’s money on the “outside” and help them enjoy food again?  Are we missing the social aspects of eating by recommending oral supplements first?  Could we achieve the same goals by discussing meal frequency?  Is this what you would want served to you?  Three times a day?

So, in the meantime, here are some quick, Boost High Protein (240kcals and 15grams of protein) equivalents in “real food.”  Enjoy!

  1. 3 whole eggs, hard boiled (232 kcals and 19 grams of protein)
  2.  4 Tablespoons of creamy peanut butter and ½ cup of frozen blueberries (228 kcals and 16g of protein)
  3. 6 oz of greek yogurt and 1 fresh peach (283 kcals and 12 grams of protein)
  4. 2 cups frozen fruit, 1 cup of milk and 3 tablespoons of peanut butter (blended), (524kcals and 28 grams of protein)
  5. 1 cup of dry milk (prepared with water) , (240kcals and 24grams of protein)