Geriatricians: Beware ‘Liquid Candy’May 28, 2014
Bottles of liquid nutritional supplements have become such staples in older people’s refrigerators, in nursing homes and assisted living facilities, and in hospitals, that it’s easy to assume they serve a useful purpose for seniors who are losing weight.
The American Geriatrics Society declared otherwise in its most recent set of Choosing Wisely recommendations, issued in February and intended to caution doctors and patients about questionable procedures, drugs and practices. As I reported then, it advised against using such products (and prescription drugs that supposedly stimulate appetites).
At the society’s annual scientific meeting in Orlando, Fla., last week, Paul Mulhausen, who led the geriatricians’ Choosing Wisely work group, took even more direct aim at drinks like Boost and Ensure and similar generic brands. Pointing out in his presentation that their primary ingredients are water and several forms of sugar, as well as some oils and proteins and flavorings, he called them “liquid candy bars with vitamins.”
An eight-ounce bottle of “rich chocolate” Boost Original, for instance, contains 10 grams of protein — but also 28 grams of sugar and no fiber. Ensure boasts that in its original formulation sugar content has fallen to 15 grams from 22 grams. Froot Loops and Lucky Charms have much less sugar per serving than these drinks.
“They’re marketed as something that helps you be vigorous and well as you age,” Dr. Mulhausen, chief medical officer for Telligen, a health management company based in Iowa, told me in an interview. TV commercials urge seniors to “stay strong, stay active, with Boost.”
But, Dr. Mulhausen pointed out, “the only place their value is clear for typical older patients is when people are malnourished, very sick and in a hospital” — as reported in a 2006 review in the Annals of Internal Medicine.
In other settings or for other people, there’s no evidence that such supplements affect mood, functional ability, quality of life, or survival, even if they do add a few pounds. (They can also cause gastrointestinal symptoms.)
“When people have weight loss, they should be seen by a physician,” Dr. Mulhausen said. If an underlying disease is the reason, Ensure won’t be much help. If an older person is having trouble consuming enough healthy food — because he can’t shop or cook, because she has trouble using utensils or chewing, because a low-salt diet is so unappetizing he doesn’t want to eat, because mealtimes are lonely and boring — liquid supplements still aren’t a good solution.
Instead, geriatricians urge that caregivers — both family and professionals — find ways to help older people eat real food. Seniors may respond to a liberalized and more palatable diet, or a more social environment at mealtime. (Adult day programs can be a good way to provide those.) They may need assistance with eating.
That takes time, a commodity overworked aides in understaffed nursing homes often lack. It’s easier to open a bottle of Boost. But unless an older person is hospitalized and undernourished, or suffering from head and neck cancer or esophageal cancer that makes swallowing difficult, liquid candy bars are seldom the way to go.