Nutritional Products: Oral Nutritional Supplements (ONS).
Some nutritional products have been specially formulated to manage medical conditions.
This means they are regarded as drugs or medications and can therefore be prescribed.
The Advisory Committee on Borderline Substances (ACBS) advises as to the circumstances in which these nutritional products can be issued on prescription.
Oral Nutritional Supplements (ONS) are one of the sub-categories of ACBS approved nutritional products and are only available on an NHS prescription if the specific criteria from the Advisory Committee on Borderline Substances (ACBS) are met.
Patients who do not meet any of the relevant ACBS criteria should be advised to purchase ONS over the counter or prepare homemade nourishing foods and drinks. Products not listed as ACBS should not be prescribed.
A list of ONS that can be purchased over the counter by patients can be accessed here.
A selection of recipes for nourishing drinks which can be freshly made are available below.
These recipes provide similar amounts of calories and protein to many of the prescribed ONS but are reported to be more palatable, which means that they are more likely to be consumed and be a more effective treatment option.
The resource details which prescribed ONS each of the recipes can replace.
If in doubt about the suitability of dietary advice because the patient has additional medical conditions that require dietary modification e.g. swallowing problems, diabetes etc, health professionals are advised to seek further advice from a Dietitian.
Homemade nourishing drinks
The fortified milk drinks listed below are the most nutritionally complete choices.
You, or the person you care for may prefer the taste of these drinks as they are freshly made and use a range of familiar ingredients. These nourishing drinks can easily be made at home.
Fortified milkshake
The fortified milkshake can be taken instead of:
- Altraplen Energy
- Aymes Complete
- Ensure Plus
- Fortisip Bottle
- Fresubin Energy
- Resource Energy
- Aymes Shake
- Foodlink Complete
- Fresubin Powder Extra
- Meritene Energis
- Aymes Shake Compact
- Foodlink Complete Compact
Portions
- Makes one portion
- One portion = 220ml
- Serve two portions per day
Ingredients
- ⅓ pint/180ml whole milk
- 2 generous tablespoons/30g skimmed milk powder
- 4 heaped teaspoons/20g vitamin fortified milkshake powder (Aldi Cowbelle, Asda Milkshake Mix, Lidl Goody Cao, Morrisons Milkshake Mix or Nesquik®)
- OR 5 heaped teaspoons (25g) ‘Ovaltine® Original Add Milk’ powder
- OR 5 heaped teaspoons (25g) ‘Horlicks® Malted Food Drink’ powder
Method
- Mix milk powder and milkshake powder together in a glass
- Gradually mix in milk and stir well
| Product comparison, per portion | Calories | Protein | Carbohydrate | Fat | Cost |
| Homemade fortified milkshake | 305 | 17g | 44g | 7.5g | £0.35 |
| Homemade fortified Horlicks® | 319 | 19.3g | 43.8g | 8.6g | £0.47 |
| Homemade fortified Ovaltine® | 319 | 18.4g | 44.3g | 7.9g | £0.55 |
| Purchased Complan® + full fat milk* | 310 | 12.5 | 44g | 8.1g | £0.93 |
| Purchased Meritene® + full fat milk* | 247 | 16.6 | 26g | 8.3g | £1. |
*Included for comparison purposes
Fortified fruit juice
The fortified fruit juice can be taken instead of:
- Altrajuce
- Aymes ActaGain Juce
- Ensure Plus Juce
- Fortijuce
- Fresubin Jucy
Prescribed juice style oral nutritional supplements are not nutritionally complete. Therefore, the fortified fruit juice recipe given here is also not nutritionally varied, however the closest micronutrient content can be achieved by using a vitamin fortified fruit juice.
Portions
- Makes one portion
- One portion = 220ml
- Serve two portions per day
Ingredients
- 180ml fruit juice (If possible use fruit juice with added vitamins – such as Vitafit® (Lidl) or Tropicana® Multivitamins)
- 40ml undiluted high juice squash or cordial (not sugar free/diet/no added sugar)
- 10g (2 x 5g sachets) egg white powder (this can be found in the home-baking section of most supermarkets or larger, better value packs can be purchased online)
Method
- Put egg white powder in a glass. Gradually stir in undiluted cordial or squash (do not whisk)
- When mixed, gradually mix in fruit juice
| Product comparison, per portion | Calories | Protein | Carbohydrate | Fat | Cost |
| High juice blackcurrant squash + cranberry juice | 212kcal | 8.4g | 42.4g | 0g | £0.80 |
| High juice orange squash + pineapple juice | 205kcal | 8.4g | 38g | 0g | £0.80 |
| High juice cranberry squash + orange juice | 182kcal | 9.4g | 34.2g | 0g | £0.82 |
| Elderflower cordial (e.g. Belvoir® or Bottlegreen®) + apple juice | 238/ 250kcal | 8.6g | 46.6/52g | 0g | £0. |
Further resources
Resources for health professionals are available here.
Food based advice for patients and carers can be found here.
Information for patients and carers about the importance of eating enough protein and about how to get enough protein from their diet can be found here.
