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Option other than Ensure
December 21, 2011 4:36 PM   Subscribe

Please recommend high-calorie, high nutrition options/meal replacements for a person who has difficulty swallowing.

A relative is newly diagnosed with Esophageal Cancer and has been recommended to keep lots of Ensure or Boost on hand. Is one better than the other?

Are there other options, particularly those that can be made at home by me?

He's meeting with his oncologist in a few days and will be asking these questions and we'll get him to a dietician soon too but I'd like some additional resources.

If Ensure really is the answer, where can I get it cheapest?
posted by otherwordlyglow to Health & Fitness (22 answers total) 1 user marked this as a favorite
 
I would imagine that a Vitamix blender would be just the thing for this situation. I would dread having to drink only sweet things all the time, but with a Vitamix you could throw practically anything in there and it would come out completely smooth.
posted by HotToddy at 4:46 PM on December 21, 2011


Check into a food thickener called Thick-it.

It was a big help for my grandmother when she started having swallowing difficulties.
posted by buggzzee23 at 4:51 PM on December 21, 2011 [3 favorites]


Also, Costco has the best prices on Ensure that I could find. We got the Ensure Plus for Grandma (it has 350 calories per bottle). IIRC, a 30 bottle case of regular Ensure was 30 bucks and 30 bottles of Ensure Plus were 40 bucks at Costco. The Plus goes a lot further.
posted by buggzzee23 at 4:54 PM on December 21, 2011


You'd probably be better off powdered protein supplements (whey, casein, powdered egg) and/or mass gainer (same, but with various carbs thrown in) than relying on that pre-bottled stuff. There are a lot of bulk supplement vendors online these days. I'm not sure of the going rate in dollars but over here I can expect to pay around £7 a kilo - that's a hell of a lot of calories that taste pretty good, can be mixed up in seconds and will keep indefinitely.
posted by Kandarp Von Bontee at 4:56 PM on December 21, 2011


But wouldn't Thick-It be exactly what he doesn't need? He has a swallow reflex but due to the tumor in his esophagus, it's painful to eat. Liquids seem to be better.
posted by otherwordlyglow at 4:58 PM on December 21, 2011


After trying a whole bunch of similar ones, my relative who needed it chose Ensure. We get it at Costco. You can get store brands cheaper at big grocery stores but I've heard they don't taste as good.

If you go to a place like Super Supplements (I don't know if that's national) you can get small amounts of many different brands.
posted by The corpse in the library at 5:03 PM on December 21, 2011


I'd talk to the doctor about just how thick food needs to be, but I have heard there is a danger if food/fluid is too thin of it going "down the wrong way" and into the lungs if you can't swallow properly.
posted by wwax at 5:22 PM on December 21, 2011 [2 favorites]


Ensure is pretty good and easy to get down, but maybe for some variety and extra nutrients, try a few blended whole foods. I do this almost daily since its the only way I can get myself to eat enough vegetables. My smoothies are usually just a kind of sludge made from 5-10 different types of frozen veggies and its not particularly tasty, but you get used to it.

On the other hand, lots of peas with some green beans, a little bit of spinach and some sunflower seeds is healthy and ends of tasting kind of like pea soup if you blend it with warm water. For dessert, just do the same thing but with fruit. Its also cheap and can be prepared in a few minutes.
posted by Dr. ShadowMask at 5:25 PM on December 21, 2011


Creme fraiche.

Also, homemade sour cream is thinner than commercial stuff and is dead simple: pour 1/4 cup cultured buttermilk into a cup of heavy cream, put a lid on the jar, shake well, and allow to sit at room temp for 24 hours. That's it!

Both these are really good and not-too-sweet when combined with roasted squash. If the texture is too thick, they could easily be thinned down with whole milk.
posted by Leta at 5:45 PM on December 21, 2011


The doctors will be able to tell you how thick foods and beverages need to be. As mentioned above, sometimes liquids are actually too thin for people with swallowing difficulties to consume safely. That's where products like Thick-It come in.

To answer your original question, back in the dark ages when I did home care with elderly patients we used to recommend Carnation Instant Breakfast to folks who couldn't afford Ensure. It still isn't cheap, but I think it's still cheap-er.
posted by camyram at 5:48 PM on December 21, 2011


Extra Virgin Olive oil added into any of those shakes or just taken as a shot is very good, cheap, calories. A shot glass full is about 300 calories.
posted by zephyr_words at 6:20 PM on December 21, 2011


when my mom was had cancer they suggested ensure. I couldn't believe how crappy the ingredients seemed.
It really seemed my fresh alternative was cheaper and healthier.
Full fat vanilla yogurt, a little protein powder and some fruit.
Banana and frozen berries were the usual.
I added trader joe's ice cream sometimes s well as full fat milk.

You could add flax oil, etc....

For variety you could also get things like natural extracts.
example... A little cocoa and exrtacts of Almond and mint and coconut... Almond joy smoothy.
posted by beccaj at 6:29 PM on December 21, 2011 [1 favorite]


You can thicken blended soups and broths with cooked rice or a slurry of cornstarch and water mixed in (bring the concoction to boiling to allow it to thicken).

I would imagine a blended bean soup would provide some welcome fiber and protein (because blended meat--ew).
posted by elizeh at 7:39 PM on December 21, 2011


I use this stuff called Ultimate Meal near religiously. $30 for a 10 serving tin, $60 for a 30 serving tin at Vitamin Shoppe.

It's a green powder & you put it in the blender with water with half an apple, a banana & frozen blueberries. It tastes ok, a little weird but ok. With extra fruits (frozen stawberries & frozen cranberries end up in mine a lot) it tastes pretty good.

One serving + fruit is about 500 calories, the way I make it with extra fruit it's probably more like 700+ calories.

It's supposed to be nutritionally complete and has plenty of fiber. It's about smoothie consistency with bits of apple peel, so I guess you could peel the apple or add more water or mix it more if it proved to be too thick.

Once made it comes out to about 3 cups of liquid and it's pretty filling (blended/whipped soups smoothies etc. are more filling than other types of soups because the combination stays in your stomach longer).
posted by MesoFilter at 8:14 PM on December 21, 2011


I have a family member who had/has esophageal cancer(a year clear! yay!). The actual swallowing is ok- it is not the same issue as elderly people or those who have throat cancer. Hence, things like thickeners for liquids are not needed. The issue is that the surgery he had, where they basically build a new esophagus out of bits of stomach, is pretty crazy and makes it pretty hard to eat most things. Also before that, the radiation was also messing thing up quite a bit, since it is basically burning the heck out of the lining of the esophagus.

He got sick of ensure/boost pretty fast, since, as noted, it is gross. He found that after the initial feeding tube and then the clear liquid stage, he could eat more things as long as they didn't have anything that even resembled an edge. Pasta had to be cooked almost to mush, as did most other things. Rice was difficult if the grains were too defined. Any sort of salad- rough greenery- was out for the most part. During radiation, there were good and bad days, and there just was a lot of experimentation, and it had to be ok to just reject things, because they were ok yesterday, but today, not so much. Having a bunch of different bits of things in the fridge/freezer is a good thing. Sherbert was pretty much always ok.
posted by rockindata at 8:42 PM on December 21, 2011 [1 favorite]


As a back-up, the Boost Plus chocolate flavor is far more tolerable than most of those nutrition supplement drinks. The telltale aftertaste is not absent, but it doesn't sock you in the nose like Ensure does.
posted by desuetude at 10:28 PM on December 21, 2011


Try whole faye yogurt. 100g has 10grams of fat. It's good by itself too. They also make it in 2% and 0%.

Congee/Jook would also be good because it can be cooked to the point of mush. Use Japonica (sushi rice is another name) instead of Basmati.
posted by Ms. Moonlight at 12:29 AM on December 22, 2011


People I have worked with who have oesophageal difficulties have eaten a lot of very smooth soups - add cream for extra calories. Ensure/Fortisip/Calogen or whatever you have locally are great because they're super loaded with calories for those days when it's too painful or too effortful to eat. Eating may become more of a chore than a pleasure and that's when ensure etc is really good to just make it as quick as possible.

You can try pureeing, but you might find it's too thick. If this is the case you can thin it with sauce or gravy, but you might need to make low-salt versions so that the meal doesn't get unpleasantly salty. For example, cottage pie, blended with extra gravy.

Depending on the treatment, chemo and radiotherapy can change people's taste, so everything tastes horrible or tastes of nothing. This affects appetite.

Agree with the above on drink thickeners - you should only use them if recommended by a speech therapist or someone similarly qualified to assess swallowing and I suspect they would make it worse, not better in this case.
posted by kadia_a at 1:45 AM on December 22, 2011


You might ask the doctor about adding liquid vitamins to your homemade smoothies or soups. That might help add nutrients in case it is not a complete diet otherwise.
posted by CathyG at 4:04 PM on December 22, 2011


Hi, I see that no one has mentioned this, so here goes.

You can buy canned coconut milk (Nature's Forest is a good quality one). It's very cheap, and provides LOTS of calories.
You want to get the full-fat stuff, not the lite. Each can has about 700 calories.

You can make curries or shakes with this coconut milk. For curries, you could mince the meat and vegetables in a food processor and cook them until they're down to a pulp.
You could use shredded chicken, carrots, sweet poatoes, white potatoes, turnips, and onions, for example.
Here's the spices you could use: http://simplyrecipes.com/recipes/chicken_curry_in_a_hurry/

Another good thing for your relative would be bone stock. The homemade kind (the store-bought stuff is mostly water, flavor and color).
Since he's not able to eat vegetables and such, the bone stock will give him lots of minerals.

What you do: go to a butcher counter and ask for soup bones. Or if you make a roast chicken, keep the bones. Keep them in a baggie in the freezer until you have enough.

Roast the bones at 400F until they have a rich browned color.
Then add cold water to a big soup pot, add the bones, and (now all this is optional) onions, shallots, carrots, celery, you can also add meat scraps (don't mix animals, though!). You can also add a bay leaf.
Add just enough water to cover the bones.
Leave on a low-simmer for 8 hours (chicken) and 40 hours (beef). You can do it on the stove-top or the Crockpot.
When done, strain, and keep in tupperware or mason jars. It keeps very well in the fridge or the freezer. Doesn't go bad.

The vitamins and minerals from the bones and vegetables will stay in a water, so it will be very nutritious for your relative.

He can drink the stock plain (as if it were tea) or add it to vegetables and make a blended soup (broccoli, etc)

Coconut milk and the stock are so nutritious, this should be all he needs.
I hope this helps. As a bonus, it's all very tasty.
posted by midnightmoonlight at 4:12 PM on December 25, 2011


Oh, if he drinks the bone stock, he won't need vitamins.
posted by midnightmoonlight at 4:12 PM on December 25, 2011


Bah, I'm so bad at giving instructions, sorry... This page has better information on bone stock.
http://www.westonaprice.org/food-features/broth-is-beautiful
(Scroll down, waaaay down).

Good luck, wishing your relative the best.
posted by midnightmoonlight at 6:42 PM on December 25, 2011


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