Supplements: I'm Not Buying the Hype

Every 4 months or so, our hospital gets a visit from our friendly supplement rep. If you work in a clinical setting, you’ve probably come to know yours as well as I have. She, and it’s usually a she, shows up with a new supplement or research to share. She’s a nice person, friendly, and easy to talk with. But, at the end of the day, she is trying to sell a product and I’m not buying.

Let’s think about your average protein supplement. There are a few major ones out there such as Boost or Ensure. What do they contain exactly? There’s a whole lot of sugar, some protein powder, a multivitamin, and maybe some extra supplements such as specific amino acids, fish oil, or the like. These supplements, while expensive for the average consumer, are sold at a very reasonable price to hospitals and can be provided by a doctor’s or dietitian’s order in most cases. They’re shelf-stable and can be provided on a patient’s meal tray and kept in their room.

What’s so bad about them? There are a few reasons why I have serious concerns about providing supplements. The following are the primary reasons why I and hopefully most of us, are reluctant to turn to these choices.

1.

We don’t know the long-term benefits or risks

We know that nutrients are best digested and absorbed when they’re provided by real foods. That means it’s better to eat a serving of carrots than taking a vitamin A supplement. Similarly, we don’t really know the long term risks of taking a highly processed supplement. Sure. It may contain arginine, fish oil, and other nutrients that provide benefits, but we have limited or no research showing that your patient needs to receive those nutrients from that particular supplement.

2. We know that these supplements are high in sugar

When I first tried providing a supplement to a patient early on in my career, his reply was that he wouldn’t drink it because it was high in carbohydrates (ie sugar). His concern was well-founded and, even for our non-diabetic patients, we should share that same concern. There are some supplements that contain slightly less sugar than the standard, but they’re still giving you a significant amount. As dietitians, we know that decreasing added sugars is essential for our general health so can we really provide these supplements?

3. They’re the easy way out

At the risk of stepping on some toes, it’s easy to order a supplement for someone. It’s more difficult and time consuming to sit down with patients and families, determine the cause of their poor appetite, and then find the best solution. In my first job out of graduate school, I found that many people wouldn’t drink the supplement. So, instead, I began asking the kitchen to send greek yogurt smoothies or milkshakes with meals (the milkshake was my second choice). Unsurprisingly, people drank them and liked them. Not only were both of these options high in calories and protein, they also were made from real foods and were, in my mind, superior.

This wasn’t easy though on the kitchen. When I made these requests, it added significantly to the labor cost for our kitchen and the food cost for each meal. In the tight healthcare budget where every dollar is pinched, my clinical manager wasn’t my biggest fan. Nevertheless, she persisted!

4. Our research is faulty

When I was studying the ASPEN curriculum, the chapter on aging reported that a validated intervention for malnourishment in the elderly was a protein supplement. That’s true in the same way that research demonstrates my cat loves Purina Pro Plan the best of all the cat foods. She hasn’t tried any other types of cat food.

In the same way, supplements have been studied using very poor methodology. Yes, we know that providing ensure is better than nothing. But anything is better than nothing. In the primary study used to promote Ensure Enlive, Abbott provided patients with either a 20-gram protein containing supplement or a protein free drink that was low in calories. Their study found that the protein supplement was better. While not surprising, this study cannot be used to defend their product.

And, while we do promote supplements for the elderly population, there are other options. Meals on Wheels, for example, is a great program that can help house-bound individuals to receive two nutritionally adequate meals per day. Other programs have been developed such as Silver Cuisine, a mail order meal service company developed by a doctor and dietitian team. Even many of the frozen “TV” dinners have nutritional value and are fairly affordable as well as easy to prepare.

Final Thoughts

I do think that these supplements have a place but it is a very small place and their use must be under scrutiny. Bringing this discussion to a personal level, I would never recommend these supplements to my parents if they were unable to prepare their own meals. In fact, I’d be willing to spend a significant amount of time and energy providing alternate ways for them to maintain a healthy diet. So, why aren’t we doing the same for our patients?

Providing these supplements should be a last-attempt rather than our first intervention. We need to work with our hospital kitchens and dietary managers to promote developing and using alternate house-made supplements as needed. Finally, we need to work with our patients and families prior to discharge and provide them with easy and manageable steps to ensure that they receive adequate nutrition once they leave the hospital. It’s not an easy solution but I do believe it’s the best.