Doctors recommend these “oral nutritional supplements” to patients who are struggling to eat, and hospitals use them for the same reason. Packed with calories, vitamins, and minerals in a few easy-to-drink ounces, they can be useful, even lifesaving.
That’s what they were created for more than 50 years ago.
For someone eating normally, some formulas may look more like sweetened, highly processed drinks than medical nutrition products. That comparison depends on the specific formula, label, and the drinks’ intended user.
The bottles themselves have become harder to tell apart as new products fill grocery shelves, and the marketing stretches from recovering patients to healthy adults.
Knowing what each bottle was built to do, and whether you have the problem it solves, can help you decide if one of these drinks is helpful for you.
A New Form of Nutrition
Other companies followed. Boost arrived in 1995 and is now the other household name. Store brands also offer products in this category, including Walmart’s Equate and Costco’s Kirkland.
The original patient-focused drinks had nutrition labels listing substantial added sugar and carbohydrates that the body rapidly digests into glucose. Newer additions to the product line cut the calories and increased the protein. Some drinks still include substantial added sugar; others much less. Exact amounts vary by flavor and formulation.
The companies call them “nutrition shakes,” a label that groups together products with different amounts of protein, vitamins, carbohydrates, and stated uses.
The expansion from clinical use to broader consumer marketing drew regulatory scrutiny. In 1997, the Federal Trade Commission (FTC) challenged Abbott’s advertising and alleged that it implied doctors widely recommended Ensure as a meal supplement or replacement for healthy, active adults.
The FTC alleged that Abbott lacked adequate evidence for those claims. Abbott settled the matter and agreed to stop making those claims.
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Same Aisle, Very Different Drinks
Some original versions contain sugar in amounts comparable to a doughnut. A bottle with 15 grams of sugar accounts for about one-third of the 50-gram daily limit for a 2,000-calorie diet. Other versions emphasize protein and list fewer carbohydrates.
On the shelf, those differences are easy to miss. Learning how to read the label is key to getting the benefits.
For many older people who struggle to eat, and for patients recovering from surgery or illness, these drinks offer essential nutrients and calories. For everyone else, the story is less clear.
What the Studies Actually Tested
A March Cochrane review of more than 3,300 such patients found that drinks like these may cut deaths—about 57 fewer for every 1,000 people treated after about a month. The certainty of that evidence was low.
One of the best-known trials came from Abbott. In 2016, researchers led by Texas A&M professor Nicolaas Deutz studied 652 malnourished older adults in the hospital. They found that the supplement drink did not reduce the odds of dying or landing back in the hospital—measured together as a single outcome. However, when researchers looked at deaths alone, about half as many patients on the specialized supplement died in the first three months.
Deutz told The Epoch Times that later research has strengthened the case that feeding malnourished patients can save lives. He pointed to an independently funded 2019 Swiss trial of about 2,000 hospitalized patients at severe risk of malnutrition. Within 30 days, 10 percent died while receiving standard hospital food compared to about 7 percent who died when they received nutrition tailored to their needs (with 91 percent of them receiving nutrition shakes).
The three studies tested different things, with different strengths. However, they all point in the same direction: for a patient who cannot eat enough, feeding is treatment.
“It will save lives,” Deutz said of feeding malnourished patients. “I don’t think there’s any doubt about that.”
The Extra Calories Have a Job
Some high-protein formulas pack 20 to 30 grams of protein and 250 to 350 calories into a bottle. Ensure Complete, for example, has 30 grams of protein and 350 calories; Boost High Protein has 20 grams and 250 calories.
Protein also needs energy to do its work, Deutz said. For someone who is losing weight and barely eating, those extra calories and protein have a job: helping the body hold on to weight and muscle.
If someone who already meets their nutritional needs uses the same drinks as a convenience food, Dahl’s food-first approach raises the question of what else the drink may replace. Added protein alone does not mean the drink contains the fiber or variety found in a meal.
If the person is not eating dinner, geriatric nutrition guidelines recommend finding out why they are eating poorly, such as ill-fitting dentures, a drug that kills appetite, depression, or no one at home to cook. Fix those problems before adding a supplement.
When the Patient Becomes the Customer
Abbott’s recent Ensure Max Protein launch used the slogan “Muscles, the New Flex,” a pitch to adults who want to keep their strength as they age. Abbott and Nestlé Health Science have also aimed at people on GLP-1 weight-loss drugs, who can lose muscle along with fat.
For healthy adults who already get enough protein from food, the added benefit remains uncertain, according to the studies discussed below.
A 2018 review of 36 trials, covering more than 1,600 older adults who were not frail, found that extra protein did not help them walk faster or stand up from a chair more easily. Most of them already got enough protein from food. A yearlong trial of 208 healthy adults over 65 found the same thing. Protein supplements alone did not make people stronger—strength training did.
“For healthy adults that can eat a normal diet, I don’t see any benefit of the supplement,” Deutz said. Extra protein can come from food or, if needed, from whey powder. To keep strength with age, he said, “You need to do exercise.”
Should a healthy 65-year-old drink one of these instead of breakfast? “No, absolutely not,” Dahl said.
Dahl said she knew of no trials showing that Ensure, Boost, or similar branded drinks improve health in generally healthy people. She then offered her opinion about why that evidence may be limited: “I expect that research hasn’t been done,” she said, “and that is likely not research the companies would be interested in pursuing.”
Abbott and Nestlé Health Science did not respond to questions about studies of their current products in generally healthy consumers.
What the Shake Replaces
Dahl compared a serving of plain Greek yogurt, which she said can offer twice the protein of one of these drinks but without the added sugar. “So why not eat the Greek yogurt instead?” Dahl asked.
She also pointed to yogurt, fruit, nuts, and whole grains as foods that can provide fiber and a range of nutrients that may not be present in a shake.
Researchers studying the gut microbiome describe those microbes as performing functions such as creating short-chain fatty acids that support immune health and may reduce inflammation.
“If nothing’s feeding their microbiome, there are lots of problems that can arise,” Dahl said.
Dahl was careful not to suggest a blanket rule, however. One of her neighbors eats doughnuts for breakfast. “Would it be better for him to have something like this than a donut? Probably yes,” she said. “We can’t have an umbrella recommendation for everybody.”
What’s Actually in the Bottle?
What the shake replaces matters. So does what is in it.
Boost Original’s ingredient list begins with water, glucose syrup, and sugar. Protein comes next. “It’s a sweetened beverage. Period,” said Dahl. “At least the originals are.”
On Ensure Original Dark Chocolate, Dahl read the label and did the math. The bottle lists 10 grams of sugar and 32 grams of carbohydrate, only 2 grams of which are fiber. About 30 grams of that carbohydrate can raise blood sugar, she said, roughly three times the number a shopper sees on the sugar line.
Store brands, including Equate and Kirkland, offer products in this category, but formulations vary, and you should review each product’s label separately.
Some product labels list vegetable oils, such as canola or corn oil, among their fat sources. Researchers differ on how to evaluate those oils. Under the NOVA framework, concern about ultra-processing focuses on the overall formulation and processing, not on any particular oil being inherently harmful. The added vitamins and minerals in these drinks can fill real gaps, Dahl said, but they do not change the ingredients underneath.
No more than 10 percent of our daily calories should come from sugars, Barry Popkin, a nutrition researcher at the University of North Carolina, told The Epoch Times. Boost, with 15 grams of sugar, is “very high sugar,” he said. “This is based on [the World Health Organization] WHO and other cutoffs.”
Are Nutritional Shakes Sugary Beverages?
“If it is not called a sugary beverage, it is because Boost and all other ‘nutritional drinks’ serve a different function. Like infant formula, it is often left out of concern due to its role in dealing with elderly nutrition.”
However, while exempting these high-sugar formulations from the category of a sugary beverage makes sense for undernourished patients, it does not make sense for anyone else, he said.
And given that these beverages are being marketed to a much wider population, it raises questions about their overall effects.
Depending on a person’s nutritional needs, alternatives with less added sugar, refined carbohydrates, or different fat sources may be available, but the appropriate choice depends on the label and medical context. For average consumers, a high-calorie formulation could contribute to weight gain if it adds calories beyond daily needs.
In some settings, like hospitals, that weight gain is desired. The same may be true for older adults who no longer cook and need essential nutrition. For consumers who already obtain adequate nutrition from meals, replacing a varied meal with a shake is most likely a nutritional downgrade.
