Dietetics - Reducing Oral Nutritional Supplements

Oral nutritional supplements (ONS) are prescribed to supplement nutritional wellbeing at a time of reduced oral intake or unplanned weight loss. ONS come in different forms such as: milkshake, juice style drink, pudding style, small dose liquid shot and powdered food fortifier.

There may be a time when ONS are no longer needed and can be replaced with other forms of nutrition.

Your GP or healthcare professional will determine when it is appropriate to begin reducing ONS. ONS should be reduced gradually, for example decreasing from twice daily to once daily, then to every other day until the supply runs out.

As ONS contains high amounts of calories, protein, and other nutrients it is important that each serving is replaced with a nourishing drink and/or a nutrient dense snack to help minimize the risk of weight loss.

An average serving of ONS can be the calorie equivalent of a small meal and can lead to the feeling of fullness. Homemade versions of nourishing drinks can be lower in calories and protein, so there is less chance of feeling full. Alternatively consume a snack at a different time of the day.

If any symptoms are experienced which contribute to weight loss (for example, nausea, vomiting, diarrhoea, or sore mouth) it is recommended you contact your GP for advice.
 
Weight should be monitored and recorded at least monthly. If your weight is decreasing, ensure to fortify meals and introduce a nourishing drink and/or high calorie/nutrient dense snack to replace the discontinued ONS.

Please note: This advice may not be suitable for people with diabetes, coronary heart disease and kidney disease. If you are unsure, please ask your healthcare professional. For additional information contact your local Dietetic Service.

High Calorie/Nutrient dense snacks – sweet and savoury

• Bread sticks/cheese straws/nachos with dips
• Scone/crumpet/muffin/bagel/teacake/fruit loaf/malt loaf/toast/ bread/crackers with:
• Jam, marmalade, lemon curd, chocolate spread, peanut butter, full fat butter/margarine, syrup/honey, fish/meat/vegetarian pate, tinned fish, baked beans, cheese, cream/cottage cheese, hummus, eggs, sliced cold meat
• Cakes/tarts/doughnuts/Danish pastry/croissant
• Biscuits – chocolate coated/cream filled
• Fruit Pie/crumble with ice cream, custard or cream
• Pancakes with ice-cream, cream, chocolate spread, syrup or honey
• Crisps/toffee coated popcorm/pretzels
• Dried fruit/nuts/seeds especially those coated with chocolate, yoghurt or honey roasted/chocolate
• Milk pudding such as rice pudding, custard, crème caramel, mousse and Angel Delight/Instant Whip made with full fat milk
• Trifle/cheesecake
• Full fat yoghurt
• Ice-cream with topping
• Cereal with full fat or enriched milk
• Cereal bar/flapjack coated with sugar, honey or chocolate
• Sausage roll/scotch egg/pork pie/cocktail sausages/quiche/mini pizza/pie/pasty

Nourishing Drinks:

Hot, milk based (use warmed full-fat milk instead of hot water)

• Milky coffee such a latte, mocha and cappuccino
• Malted drinks such as Horlicks, Ovaltine and supermarket brands
• Hot chocolate
• Soup – use packet, tinned, condensed, ‘cream of’ soups made with milk, cream, meat and/or pulses.

Cold, milk based (avoid low-fat, skinny varieties)

• Full fat milk
• Milkshake – ready to drink, shop brought varieties such as Frijj Fresh Classic Shake, Yazoo milkshake
• Rice Dream Milk
• Flavoured oat milk or supermarket brand milkshake. Available in various flavours
• Homemade milkshakes can be made by adding milkshake flavouring such as Nesquick, Crusha or supermarket brand flavouring to full fat enriched milk*
• Smoothies – ready to drink, shop bought varieties such as Innocent, Naked or supermarket brand smoothies
• Homemade smoothies can be made by blending milk/yogurt and fruit
• Yogurt drinks
• Ready to drink, shop bought varieties such as Yop drinking yoghurt, Yoplait, Frubes yoghurt drink, Petit Filous yogurt smoothie or a supermarket brand yogurt drink, all available in various flavours
• Iced coffee such as latte, mocha, macchiato and cappuccino
• Add, condensed milk, cream, evaporated milk, ice-cream, honey, chocolate sprinkles and/or marshmellows.

They can be frozen to make ice lollies, ice cream or frozen yoghurt.

Cold, non-milk based

• Non diet fizzy drinks – ready to drink, shop bought varieties such as cola, lemonade, soda/tonic water, cream soda, dandelion and burdock and ginger beer
• Add 2 scoops of ice cream to a fizzy drink to make an ice-cream float
• Fruit juice – on its own or mix with a fizzy drink

*Enriched/fortified milk (can be taken as a drink between meals ot unflavoured varieties can added to soups, sauces and puddings)

• Add 2 - 4 tablespoons of milk powder (Marvel/supermarket brand skimmed milk powder_ to a pint (568ml) of full fat milk and mix well
• Use the enriched milk to make milky drinks, packet/condensed soups, sauces, jelly, milk puddings, porridge and pour over breakfast cereals

‘Over the counter’ supplements

• Meritene, Aymes and Complan are ‘over the counter’ supplement drinks available to purchase from supermarkets/ chemists
• They come in a variety of flavours including sweet and savoury options
• These supplements can be made into milky drinks, soups and sauces