Sometimes eating sucks. When my body hurts, I'm tired, and my gut is bloated, the last thing I usually want to do is add fuel to the fire by eating a meal. This is an unfortunate situation to be in because eating is one of those things we kind of have to do to survive. Luckily, there is a way to meet our needs without really eating. Enter the oral nutrition supplement. Calorie dense nutrition shakes designed to give you all the vitamins and minerals you need for livin’ in as little volume as possible. You can down one of these bad boys in under a minute and not have to worry about figuring out how you might fit an entire meal in your distended abdomen.
There are a lot of different nutrition supplements on the market, and it can be difficult to try to figure out which to buy. There are so many factors to consider, it can almost be overwhelming. In this article, I have tackled a few of the more common factors people consider when looking for supplements. Hopefully I have been able to provide some clarification on the differences between some of the common choices for meal replacement shakes.
Calories
The amount of calories I look for in one of these supplements depends on why I am using it in the first place. Am I trying to replace a meal? Then I would probably reach for something with a higher amount of calories. I usually try for at least 250 calories per shake, but closer to 500 calories is probably better. If I am using the shake to replace a snack, maybe 200-300 calories would be more desirable.
Some nutrition supplements come as a powder that you can mix with water or another liquid. The benefit of these supplements is that you can add as much powder as you want and customize the amount of calories to the situation. Products like Modulen IBD, Huel, Garden of Life Raw Organic Meal Shake, and Super Fuel all come as mixable powders. Garden of Life is one of the lowest calorie options I have seen, coming in at 120 calories per serving.
Most ready to drink supplements also have higher calorie options available. Ensure and Boost both make higher calorie versions of their regular nutrition shakes. You can usually tell a higher calorie shake because it will have the word “plus” in the name, i.e. Ensure Plus or Boost Plus. The big downside of these higher calorie versions is that a lot of the extra calories come in the form of sugar.
Fat
Fat is a tricky one. Often demonized, fat plays an important role as a source of energy, absorption of certain fat soluble vitamins, and managing inflammation. Certain fats are even essential, which means that we must get them from our diet. The type of fat in nutrition supplements matters. In most supplements, the fat content will be from vegetable oils. Animal fats are unusual or minimally used due to their tendency to be solid at room temperature.
Certain fats in vegetable oil, such as the Omega 6 fatty acids, are sometimes mis-labeled as pro-inflammatory. While these fats can be used by the body to create inflammatory molecules, research has shown that omega-6 fats are associated with lower or unchanged markers of inflammation. If you are somebody who is concerned about these fats, choose a supplement higher in monounsaturated fats such as Orgain or Huel. Looking for the words “high oleic” in the ingredients list is a good way to know that the oil used is high in monounsaturated fats. One supplement, Super Fuel, actually lets you add the fat to your shake yourself, so you can choose the exact type of fat you want!
Carbohydrates
There are a lot of considerations when looking at the carbohydrates in nutrition supplements. Some of the important things in my opinion are the sugar content, presence of artificial sweeteners, presence of maltodextrin, and fiber.
Sugar is an interesting one. The International Organization for the Study of Inflammatory Bowel Disease (IOIBD) says in their guidelines that there is insufficient evidence to recommend any specific change of intake of complex carbohydrates or refined carbohydrates or refined sugars and fructose. Therefore, any reason to limit sugar would have to be based on the known effects of high sugar consumption on heart health, gut health, weight gain, and other markers of health. Many of these supplements are high in added sugars, so it might be prudent to look for some of the lower sugar options such as Super Fuel, Huel, Orgain, or Garden of Life.
Some supplements contain ingredients that might be harmful in IBD patients. Specifically, maltodextrin and artificial sweeteners. Some of the low sugar supplements, such as Premier Protein, use artificial sweeteners like sucralose to replace sugar as a source of sweetness. Most supplements found in stores, including Ensure, Boost, and store brands such as Equate contain maltodextrin as a source of carbohydrates. In the IOIBD guidelines, the researchers note that it may be prudent to limit intake of both maltodextrin and artificial sweeteners. The authors also note, however, that the evidence for maltodextrin is theoretical and mostly based on animal models. Nutritional therapies that involve consuming nutrition supplements with maltodextrin have been found to be effective in IBD, so the jury is still out on maltodextrin.
Fiber is also a hot topic in IBD. Many foods considered healthy contain fiber, but many IBD patients who are flaring consider fiber to be something that aggravates their disease. Many of these supplements contain very small amounts of fiber, usually between 1-2 grams per serving. Some supplements, such as Huel, Kate Farms, and Super Fuel contain a higher amount of fiber. The general consensus from what I have researched appears to be that if you tolerate fiber, more is better. Like many other factors in IBD, fiber seems to be something to consider on an individual basis. Of note, Walmart’s brand Equate was the only supplement I looked at that had 0 grams of fiber per serving.
One thing to note is that some supplements include blends of fruits, vegetables, and other plant compounds. Orgain, Garden of Life, and Kate Farms all include these special blends, likely to try to mimic the benefits of eating whole foods. Other supplements, such as Huel and Super Fuel are made primarily from whole foods.
Protein
The protein needs of an IBD patient are increased during a flare. Protein is needed to help repair damaged tissue and maintain muscle mass, among many other functions. I think it is important to make sure that the nutrition supplement you choose has the protein your body needs to function optimally.
Most supplements have enough protein to meet your body's needs. A little trick I use is to try to shoot for 20% of calories from protein. You might need to whip up your phone calculator in the store, but the math isn’t too hard. First you would take the grams of protein and multiply it by 4, because there are 4 calories in every gram of protein. Then, all you need to do is divide the number of calories of protein by the total calories and multiply by 100 to get the percent!
Let's do an example with Orgain’s Nutritional Shake:
Looking at the bottom, we see Orgain has 16 grams of protein per serving.
Step one would be to multiply 16g by 4 to get the number of calories, which would be 64 calories of protein.
Step two, would be to divide the number of protein calories by the number of calories in a serving, which can be seen at the top of the nutrition facts label.
We would do 64 calories divided by 250 calories and get 0.256.
The final step, to get a percentage, would be to multiply by 100 to make that number a percentage. So, .256 multiplied by 100 is 25.6%.
25.6% is more than 20%, so Orgain would pass my little test!
Some of the higher protein supplements out there are Huel, Ensure Enlive, and Premier Protein, and Garden of Life. It is important to note that if you aren’t in a flare, your protein needs are likely no higher than the rest of the population.
Carrageenan
Carrageenan is an emulsifier used to help the ingredients in shakes mix smoothly. It has also been shown to cause a variety of negative effects in animal models, such as increased blood in stool, increased inflammatory markers, and lesions in the bowel. For these reasons, and some small scale human research, IOIBD also states that it may be prudent to reduce intake of processed foods that contain carrageenan in both UC and Crohn’s Disease. Most of the supplements found in stores, such as Ensure, Boost, and store brands such as Equate use carrageenan in their nutrition supplements. If carrageenan is something you wish to avoid, you can usually locate it at the bottom of the ingredients list. You can see it is the last ingredient in Ensure Plus.
To Conclude
I wish I could add more detail, but I don’t want to break your scroll wheel. The most important thing to do when looking for an oral nutrition supplement is to take a look at the nutrition facts label and make sure you are comfortable with the nutrition content and ingredients in your shake. I usually try to look for higher protein and fiber, and lower added sugars while avoiding sucralose, maltodextrin, and carrageenan. Oh and the shake has to taste good too. Could you imagine not wanting to eat anything and reaching for a shake that didn’t even taste good? Neither could I. Considering all that, I usually go for Orgain nutritional shakes. They fit my goals as far as cost, taste, and nutritional content are concerned.
Another option is to try to make your own shake in a blender. It can be pretty easy to toss some oats, a banana, and a few scoops of peanut butter together and have a tasty, nutritionally dense smoothie to sip on. You even save some money that way too! At the end of the day, store bought shakes or homemade, oral nutrition supplements can be a great way to give your body the fuel it needs to function when you don’t feel like making or eating a meal.