How To Choose A Supplemental Nutrition Shake

By Katie Grubiak, RDN at Side by Side Nutrition (formerly at EDTLA)

Choosing a nutrition shake to support eating disorder recovery can be a daunting process.

In a previous post, we discussed the role of supplemental nutritional shakes in eating disorder recovery. Sometimes, patients in recovery will be unable to restore their nutrition entirely with food. Families doing FBT often report having supplements as a tool can be helpful in helping a teen with anorexia gain weight. In these cases, the use of supplements can be invaluable. If you or a loved one are restoring nutrition from an eating disorder, you should be under the care of a medical doctor (MD) & registered dietitian nutritionist (RDN).

In this post, we will continue the discussion about supplements, comparing different supplement brands based on caloric density per ounce, macronutrient comparison (fat, carbohydrates, protein), and label advertising. Lastly, we’ll rate them for taste and palatability.

Caloric Density

Substantial caloric density per ounce is the most important factor in the selection of a liquid supplement. To optimize replacing calories in a meal, we recommended selecting a product that delivers at least 300 calories per 8- to 11-ounce serving. Any under-300 calorie product is insufficient to replace a meal or even a majority of a meal for someone in recovery from an eating disorder, and should instead be treated as a calorically dense beverage to be added alongside a meal or snack. Alternatively, multiple shakes—2 or 3—can together replace a meal.

Serving size is important. Any product that comes in serving sizes larger than 11 ounces has the risk of being too filling—someone recovering from an eating disorder may not finish it, meaning that the precious calories will never be delivered.

Macronutrient Comparison

A comprehensive liquid supplement should be evaluated against the same dietary recommendations as a normal meal. The caloric nutrients or “macronutrients” that we hope to balance in a meal are protein, carbohydrates (carbs), and dietary fat. The goal is that supplements have a macronutrient profile similar to a balanced plate.

Macronutrients are often measured in terms of “exchanges”:

• Fats: One dietary fat exchange equals 5 grams of fat. A recovery meal is often recommended to include at least two to four fat exchanges. Aim for 10-20 grams of fat in an 8-11 ounce supplement.
• Carbohydrates: One carb exchange equates to 15 grams of total carbohydrates. Meals in recovery are recommended to include at least two to four carb exchanges. Aim for 30-60 grams total carbs in an 8-11 ounce supplement.
• Protein: One ounce of meat, chicken, or fish equates to one protein exchange, or 7 grams of protein. Meal-building suggestions for animal or vegetarian protein sources are usually anywhere from two to four exchanges. Aim for 14-28 grams of protein in an 8-11 ounce supplement serving.

I don’t advise comparing micronutrients—the trace amounts of added vitamins and minerals—among products because this is not important when the goal is increased intake. Instead, stay focused on the caloric constitution of a supplement including its macronutrient profile so that the primary objective of ensuring weight gain or maintenance is achieved.

Looking at Ingredients

Products labels sometimes contain so much “health” messaging that it is difficult to discern what is truly important. One product label claims a better, more natural ingredient; another vouches it is more “non”-something than any other product…. This can get confusing!

To streamline the process, we recommend starting off with identifying whether or not the product is dairy-free. This is an important concern for people who keep Kosher, are lactose intolerant, or have a milk protein allergy. Look specifically to see if the product says dairy-free, or suitable for lactose intolerance (might have dairy/lactose but in low concentrations). If you have a milk protein allergy, specifically screen for such ingredients as milk protein concentrate, casein (all forms), whey (in all forms), & milk (in all forms).

Second: identify whether or not gluten is an issue for you. You only need to do this if you have a known gluten issue diagnosed by a medical professional—for most people, gluten is a harmless component of a normal diet. If gluten is an issue, check to see whether the supplement is labeled gluten-free.

Third: check the label for any other known food allergy ingredient.

Last, check the “Nutrition Facts” on the back label for calorie and macronutrient comparison. I suggest stopping there and not diving into a deeper ingredient comparison. Any scrutinizing beyond this is unimportant and likely giving the eating disorder too much power. In the end, this kind of label attention diverts from the true function of the use of supplementation in eating disorder recovery—to replace calorically a substantial meal with a concentrated liquid when all or partial meal cannot be consumed.

Focus on Ensuring Enough Calories

To reiterate, your primary considerations when choosing a supplement are caloric density and macronutrient profile. Weight maintenance and weight gain comes from calories—not from the presence of more natural ingredients or the absence of processed ones. It’s understandable to want to use a supplement that checks off every box marked “healthy”—but this can add fuel to the eating disorder’s fire.

Labeling is part of the product—you can’t avoid it. But you don’t have to let the eating disorder make choices based on irrelevant labeling information that appeases its instincts. When you provide a supplement to a family member in recovery, you can always remove or cover up the label, or simply pour it into a cup, to reduce a triggering reaction.

Taste Test and Nutritional Profiles of Various Nutrition Shakes

EDTLA reviewed a number of supplement brands and taste-tested some of them. Taste was rated on a scale of 1 (yuck) to 10 (yum). Each brand has numerous product variations in its lineup—we were not able to review every variety. Note that many drugstore and grocery chains carry their own store brands – of these, we also tasted and analyzed Rite Aid, CVS, and Kroger store brands.

Ensure Product Family

Ensure Original

Product positioning: #1 doctor-recommended brand, kosher, gluten-free, suitable for lactose intolerance, not for people with galactosemia

Calories: 220 calories per 8-ounce serving

Macronutrients: 6 g fat, 33 g total carbs, 9 g protein

Ingredients: Carbohydrate sources: corn maltodextrin, sugar. Protein sources: milk protein concentrate. Fat sources: canola oil, corn oil

EDTLA TASTE RATING: Not tasted

Ensure Plus

Product positioning: 50% more calories than Ensure Original, gluten-free, suitable for lactose intolerance, not for people with galactosemia, balanced nutrition to help gain or maintain a healthy weight, kosher, gluten-free, suitable for lactose intolerance

Calories: 350 calories per 8-ounce serving

Macronutrients: 11 g fat, 50 g total carbs, 13 g protein

Ingredients: Carbohydrate sources: corn maltodextrin, sugar. Protein sources: milk protein concentrate, soy protein isolate. Fat sources: blend of vegetable oils (canola, corn).

EDTLA TASTE RATING: Chocolate flavor 8; Strawberry flavor 7; Vanilla flavor 8

Ensure Enlive

Product positioning: designed to help rebuild your strength and energy from the inside, with an ALL-IN-ONE blend to support your health. The label claims bone, muscle, heart, digestion, & immune support, flavored-natural & artificially flavored, suitable for lactose intolerance, gluten-free, kosher, not for people with galactosemia

Calories: 350 calories per 8-ounce serving

Macronutrients: 11 g fat, 44 g total carbs, 20 g protein

Ingredients: Carbohydrate sources: corn syrup, sugar, short chain fructo-oligosaccharides. Protein sources: milk protein concentrate, sodium caseinate, soy protein isolate, whey protein concentrate. Fat sources: corn oil, canola oil.

EDTLA TASTE RATING: Strawberry flavor 8

Ensure Clear

Product positioning: great-tasting, clear liquid nutrition drink that contains high-quality protein and essential nutrients, fat free, gluten-free, suitable for lactose intolerance

Calories: 200 calories per 6.8-ounce serving

Macronutrients: 0 g fat, 43 g total carbs, 7 g protein

Ingredients: Carbohydrate sources: sugar, corn syrup solids. Protein sources: whey protein isolate

EDTLA TASTE RATING: Apple flavor 8. Also available in mixed berry (not tasted)

Boost Product Family

Boost

Product positioning: a great-tasting nutritional drink as a mini-meal or between-meal snack with 26 vitamins & minerals, 3 g of fiber, & 10 g of high quality protein, gluten-free, suitable for lactose intolerance, not for individuals with galactosemia, kosher

Calories: 240 calories per 8-ounce serving

Macronutrients: 4 g fat, 41 g total carbs, 10 g protein

Ingredients: Carbohydrate sources: corn syrup, sugar, fructo-oligosaccharides. Protein sources: milk protein concentrate, soy protein isolate. Fat sources: vegetable oil (canola, high oleic sunflower, corn)

EDTLA TASTE RATING: Not tasted

Boost Plus

Product positioning: helping to achieve and maintain a healthy weight, 3 g fiber, 26 vitamins & minerals, gluten-free, suitable for lactose intolerance, not suitable for people with galactosemia, kosher

Calories: 360 calories per 8-ounce serving

Macronutrients: 14 g fat, 45 g total carbs, 14 g protein.

Ingredients: Carbohydrate sources: corn syrup, sugar. Protein sources: protein concentrate, soy protein isolate, fructo-oligosaccharides. Fat sources: vegetable oil (canola, high oleic sunflower oil, corn)

EDTLA TASTE RATING: Chocolate flavored 6; Vanilla flavored 5

Boost Breeze

Product positioning: a convenient source of extra protein & calories in a fruit-flavored drink, suitable for lactose intolerance, gluten-free, kosher, not for individuals with galactosemia

Calories: 250 calories per 8-ounce serving

Macronutrients: 0 g fat, 54 g total carbs, 9 g protein

Ingredients: Carbohydrate sources: sugar, corn syrup. Protein sources: whey protein isolate (milk)

EDTLA TASTE RATING: Peach flavored 7 (“like peach Snapple”); Berry flavored 6 (“like Hi-C”), Orange flavor 3 (“medicine like”)

*BOOST VERY HIGH CALORIE (NEW AS OF 2021)

EDTLA Guest Taste Review: “I rate VHC taste when cold an 8. It is smooth, and naturally flavored and the creamy texture is fulfilling. Being lactose-free is a definite plus. A big bonus for me is the small size yet packed with nutritional value making the experience less daunting.”

 

 

Store Brands

Rite Aid Original Nutrition Shake

Product positioning: advertised compared to Ensure, natural & artificial flavors, gluten-free, suitable for lactose intolerance, not for people with galactosemia, kosher

Calories: 220 calories per 8-ounce serving

Macronutrients: 6 g fat, 33 g total carbs, 9 g protein.

Ingredients: Carbohydrate sources: corn maltodextrin, sugar, sucromalt. Protein sources: milk protein concentrate, soy protein isolate, pea protein concentrate. Fat sources: soy oil, canola oil

EDTLA TASTE RATING: Chocolate flavored 6

CVS Nutritional Shake

Product positioning: – naturally & artificially flavored, made with real diafiltered milk, gluten free, suitable for lactose intolerance, kosher

Calories: 220 calories per 8-ounce serving

Macronutrients: 6 g fat, 33 g total carbs, 9 g protein.

Ingredients: Carbohydrate sources: sugar, brown rice syrup, corn maltodextrin, sucromalt. Protein sources: milk protein concentrate, soy protein concentrate. Fat sources: soy oil, canola oil, corn oil. Diafiltered skim milk contributes to carbs & protein amount simultaneously.

EDTLA TASTE RATING: Milk chocolate flavor (not tasted)

Kroger Nutrition Shake Fortify Plus

Product positioning: -advertised as to help gain or maintain a healthy weight & kosher, naturally & artificially sweetened milk chocolate

Calories: 350 calories per 8-ounce serving

Macronutrients: 11g fat, 50 g total carbs, 13 g protein.

Ingredients: Carbohydrate sources: corn maltodextrin, sugar. Protein sources: milk protein, soy protein isolate. Fat sources: corn oil, canola oil.

EDTLA TASTE RATING: Chocolate flavored 6

Orgain Organic Nutrition Product Family

Product positioning: weight management, meal replacement, or for medical needs;-also gluten-free, soy-free, non-GMO, high protein, organic & kosher.

Complete Protein Shake-Sweet Vanilla Bean

Designated as Grass Fed Dairy

Calories: 250 calories per 11-ounce serving

Macronutrients: 7 g fat, 32 g total carbs, 16 g protein

Ingredients: Carbohydrate sources: organic brown rice syrup, organic cane sugar, organic rice dextrins. Protein sources: organic grass fed milk, protein concentrate, organic whey protein concentrate. Fat sources: organic high oleic sunflower oil

EDTLA TASTE RATING: 4

Plant-Based Protein Shake-Smooth Chocolate

Designated as Vegan & Dairy Free

Calories: 220 calories per 11-ounce serving

Macronutrients: 6 g fat, 25 g total carbs, 16 g protein.

Ingredients: Carbohydrate sources: organic rice dextrins, organic cane sugar. Protein sources: organic brown rice protein concentrate, organic hemp protein concentrate, organic chia seeds, organic flax powder. Fat sources: organic high oleic sunflower oil

EDTLA TASTE RATING: 4

Kate Farms Product Family

Product Positioning: certified gluten free, free of common allergens (no milk, wheat, soybeans, peanuts, tree nuts, eggs, fish, shellfish), corn-free, 18 g plant based protein, MCT oil in some varieties, 29 superfoods, kosher. Contains organic ingredients. Kate Farms is a family start-up company based on the love and re-nourishment of a daughter with Cerebral Palsy. This is a great choice if looking for a multi-tiered caloric supplement company that is non-dairy and has alternative macronutrient sources than the mainstream brands. Kate Farms Core Essential Formulas may be covered by insurance for oral use and tube feeding. Coverage depends on the patient’s diagnosis and insurance plan.

Komplete

Calories: 290 calories per 11-ounce serving

Macronutrients: 8 g fat, 41 g total carbs, 16 g protein

Ingredients: Carbohydrate sources: brown rice syrup solids, organic agave syrup. Protein sources: organic pea protein, organic rice protein. Fat sources: organic high oleic sunflower oil

EDTLA TASTE RATING: Available in Chocolate/Coffee/Vanilla (not tasted).

Core Essentials Standard Formula 1.0 cal/mL

Calories: 325 calories per 11-ounce serving

Macronutrients: 10 g fat, 41 g total carbs, 18 g protein

Ingredients: Carbohydrate sources: brown rice syrup solids, organic agave syrup. Protein sources: organic pea protein, organic rice protein. Fat sources: organic high linoleic sunflower oil, medium chain triglycerides (MCT) derived from coconut oil.

EDTLA TASTE RATING: 4 chocolate flavor, 2 vanilla flavor “chalky”

Core Essentials Peptide Plus 1.5 cal/mL

Calories: 500 calories per 11-ounce serving

Macronutrients: 25 g fat, 41 g total carbs, 24 g protein

Ingredients: Carbohydrate sources: brown rice syrup solids, organic agave syrup. Protein sources: organic hyrolyzed pea protein, organic rice protein. Fat sources: organic sunflower oil, medium chain triglycerides (MCT) derived from coconut oil, organic flax seed oil.

EDTLA TASTE RATING: Plain flavor 1 (perhaps best not to drink alone but add to a shake or mix in foods for extreme nutrient density or just use in tube feedings)

Other Brands/Products

Benecalorie

Product positioning: calorie and protein food enhancer, mixes easily into most foods & beverages including milkshakes, yogurt, hot cereal, and mashed potatoes. It is unflavored, suitable for lactose intolerance, gluten-free, kosher, not for people with galactosemia, not recommended for tube feeding (not a liquid)

Calories: 330 calories per 1.5-ounce serving

Macronutrients: 33 g fat, 0 g total carbs, 7 g protein

Ingredients: Carbohydrate sources: no carbohydrates but does contain the artificial sweetener sucralose. Protein sources: calcium caseinate from milk. Fat sources: high oleic sunflower oil

EDTLA TASTE RATING: By itself: not tasted. Mixed into oatmeal as suggested 7 (“not a significant change in taste or texture of oatmeal”)

We hope this review is helpful and provides encouragement to venture into supplements if recommended by your treatment team.

Get Help With an Eating Disorder California

Reach out to Eating Disorder Therapy LA for psychological counseling.

For dietary counseling, reach out to Katie Grubiak, RDN at Side by Side Nutrition.