Are substitute shakes good at providing substitute nutrition?

Cundiff: “Protein shakes and drinks should not be a substitute for real food. Depending on an individual’s health status, there is the risk of consuming an excess of protein at one time, food allergies, GI distress and possible increased vitamin/mineral intake causing interactions with medications.

“I’m always an advocate for food first, but if an individual finds themselves not getting adequate balance with their nutrition due to a variety of health needs, this could be used to help balance out nutrition intake. “

What are your thoughts on substituting meals with shakes (protein or others)? And why might someone choose a liquid substitute over a more traditional meal?

Cundiff: “Food first always, but with life being as busy as it is, I think protein shakes or higher protein smoothie type drinks are a good way to quickly consume protein. The first reason is convenience. Protein drinks are easy to put together or are available in ready-to-drink forms in a variety of settings from grocery stores, convenience stores and gyms. Other reasons would be as a post-workout recovery drink to aid in muscle recovery, use in in a weight loss program or used for weight gain.”

Protein shakes and drinks should not be a substitute for real food.
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What are the health benefits and risks of substituting?

Cundiff: “Many protein drinks provide a quality, highly absorbable protein when protein-dense foods are not easily accessible. Along with protein, there are other added vitamins and minerals, which can contribute to our daily nutrient needs. Other health benefits would be for individuals who are trying to maintain or gain weight secondary to an illness or medical treatment. There is always the risk of consuming ‘too much of a good thing.’”

What are some things to look for or avoid when choosing a substitute drink or protein shake? Any specific ingredients?

Cundiff: “First, I recommend looking for a drink with a complete branched-chain amino acid profile. This means the protein in the drink is a complete protein providing all the essential amino acids. For example, whey protein is a complete protein. There are also many plant-based protein beverages available too.

“Second, I recommend looking for a drink that has around 20 to 30 grams of protein per serving. This would the right amount of protein to be considered a meal. If you are looking to use it as a snack, aim for around 10 to 15 grams. Finally, always pay attention to sugar content and try to limit excess added sugars, less than 10 grams of sugar per serving is my recommendation. Look for ingredients representing food you recognize and be cautious of extremely high protein content (greater than 30 grams) and a plethora of added sugar ingredients.”

Is there a “proper way” to consume substitute drinks or protein shakes?

Cundiff: “As a nutrition expert, I call these my ‘in-case-of-emergency’ foods. If you are traveling or you need something quick, protein drinks are a choice I recommend over high fat/calorie snack foods or fast-food dining options. I do not recommend protein drinks for kids under 18. As far as not using it properly, I do not recommend consuming more than one a day (meaning it should not replace actual food for meals).”

Are substitute drinks and protein shakes a good way to lose weight or help someone transition to a plant-based diet?

Cundiff: “It could be an aid in starting off a weight loss program but it is not ideal for sustainable weight loss. And again, I recommend food first, but if someone is transitioning over to a more plant-based diet and is not meeting their protein needs, this could be a short-term way to meet those needs.”

Is there anything else you think people should know about substitute drinks and protein shakes?

Cundiff: “I always recommend individuals contemplating using protein drinks to seek out a registered dietitian to discuss their current nutrition needs. An RD will be able to review their daily intake and determine if they would benefit from a higher protein drink.”

Substitute drinks and protein shakes can be a great quick substitute, but real food is usually a better option for your meal.

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The Takeaway: Overall, nutrition experts say overdosing is a concern that we need to pay attention to, but vitamin and mineral supplements (that we take orally in a pill or chewable form) are much more likely to be the culprit for overdosing than fortified foods.

What can you tell us about this report?

Dr. MacDonald: “Historically, foods were fortified with vitamins and minerals to address deficiencies in the population. Examples include adding iodine to salt or vitamin D to milk. Enrichment of foods has also been done to put back nutrients that were decreased by processing, including adding B vitamins and iron to white flour. But today’s store shelves are full of products that contain added nutrients to improve the quality of the foods, and to encourage consumers to buy them. So being aware of how much supplements you are consuming may be a good idea. There is potential for over-fortification, especially for children, given the wide range of foods that are being fortified, and the fact that many parents are also giving them vitamin/mineral supplements. However, whether fortified foods alone can actually create toxic levels is questionable in my view. If fortified foods are taken with supplements, especially by kids, then there could be a concern.”

Dr. MacDonald suggested we reach out to Dr. Victor Fulgoni, a consultant with Nutrition Impact, LLC. Here’s what Dr. Fulgoni had to say:

Dr. Fulgoni: “Frankly, this report has not considered the issues with the estimated average requirements of certain nutrients, especially Upper Limits (the highest average daily nutrient intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population). The main issue is how to maximize meeting nutrient needs, while not having too many people exceed the Upper Limits. And, it’s important to note we do not know the risk of nutrient intake above the Upper Limits.”

The report says that nearly half of American kids age eight and younger consume potentially harmful amounts of vitamin A, zinc and niacin because of excessive food fortification, outdated nutritional labeling rules and misleading marketing tactics used by food manufacturers. Is this true?

Dr. MacDonald: “It’s a possibility. It’s a fact that there is more fortification of foods and beverages than there used to be, and people take more supplements that have a wide range of nutrients and other botanical/biologically active compounds.”

According to WebMD, Louise Berner, PhD, a professor of food science and nutrition at Cal Poly State University whose research is cited in the EWG report, questions the report’s conclusions.

Dr. Berner: “I agree that excessive or indiscriminate fortification, particularly along with the indiscriminate or unneeded use of supplements, is a potential issue of concern, but the EWG report is worrisome to me in several respects.”

Berner explained that the EWG report doesn’t address ‘tolerable upper intake level’ or UL. UL is the highest level of nutrients our bodies can take, without the risk of harm. Berner noted two additional challenges with the report: it “selects data and summarizes findings out of context” and “mischaracterizes the main message of our published data as I interpret them.”

Why do food companies fortify foods?

Dr. Berner’s research shows that fortified foods, mainly enriched grains, breakfast cereals, milk and juice, play an important role in ensuring that children get adequate amounts of many nutrients.

Is it possible to overdose on vitamins through fortified foods or supplements?

Per Dr. Berner, supplement use, and not fortification, seems to be “the major driver of potentially high [nutrient] intakes.”

Dr. MacDonald: “Yes, that is always a possibility, as some vitamins and minerals can be toxic in high doses. While overdosing is possible, people are much more likely to overdose by taking supplements than simply by eating fortified foods. As it relates to the specific vitamins and minerals cited in the EWG report,

• Vitamin A toxicity can occur if the vitamin is consumed in the active form of retinol or retinal, but not when in the pro-vitamin A form Beta-carotene (this form of Beta-carotene is found in carrots and orange vegetables, and has to be converted to be used as vitamin A in the body) – so you need to know what form is in the food by reading the ingredient label.
• Zinc is a mineral that is poorly absorbed, in general. Our bodies adapt the amount that is absorbed depending on how much is already present. For example, if we have low levels of zinc, our body will absorb more; if we have higher levels, our body will absorb less. So with zinc, overdosing from food is probably not likely, but overdosing could occur if there is a high dose taken in a supplement. The difference between food and supplement is the overall dose at one time – if you absorb 50% of 10 grams, that is less than 50% of 100 grams. Percent of absorption is the same, but the overall amount is more.
• Niacin is a water-soluble vitamin and is usually excreted in the urine when too much of it is in our bodies. It is important to note that if taken in high doses, for example, as a drug to regulate blood pressure, then it will have biological effects.

A good rule of thumb is to not consume supplements or fortified beverages/foods that contain greater than 200 times the recommended daily value of any nutrient. And to monitor supplement intake when consuming highly-fortified foods, such as energy drinks.”

To learn more about food fortification, please visit the FDA’s fortification policy site.

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