Hazel Clarke, Specialist Plant-Based Gastroenterology Dietitian
The rising demand for plant-based nutritional solutions within healthcare is inevitable. This is especially the case, as more patients need plant-based alternatives due to following a plant-based diet. This could be due to ethical, health, or gastrointestinal concerns. As clinicians, we must ensure that nutritional support aligns with these preferences while meeting clinical needs. Historically, meeting the nutritional needs of this patient group has presented significant challenges. This blog explores the increasing demand, the specific gastrointestinal conditions that benefit from plant-based ONS, real-world case applications, and key research gaps in this growing field.
We know that plant-based diets are on the increase. This is especially the case in our younger generations. Recent reports show that millennials and Gen Z are driving an increase in plant-based diets, with up to 15% of Gen Z in the UK identifying as vegan, and 9% of millennials.1 Furthermore, dairy intolerances and allergies are common, particularly among individuals with gastrointestinal conditions like IBS, IBD, and coeliac disease, making plant-based alternatives or dairy alternatives preferable and more suitable for these individuals.
For many patients with gastrointestinal disorders, moving away from dairy and towards plant-based options can be preferable. Conditions such as:
Inflammatory bowel disease (IBD): Many individuals with IBD experience lactose intolerance, due to intestinal damage. Research indicates new IBD diagnosis are more likely to reduce dairy consumption due to symptom aggravation or worry about triggering flares.2 We also know these individuals are more at risk for osteoporosis,2therefore, having a dairy alternative to meet their nutritional and calcium needs can help.
Coeliac disease: Due to the damage caused by having gluten in their diets prior to diagnosis, those with this condition may struggle to tolerate lactose. It can take years for the lining of the intestines to recover following a gluten free diet, during this time, dairy alternatives may be preferable.3
Irritable bowel syndrome (IBS): Since lactose is a high-FODMAP food, those with IBS may have difficulty tolerating dairy. Some evidence suggest up to 85% of IBS populations have lactose intolerance.4
These conditions highlight the necessity of plant-based ONS as an option for clinical nutrition, ensuring that all patients receive appropriate and tolerable nutritional support.
A recent inpatient case demonstrates the real-world application of plant-based ONS:
Patient profile: Post-operative Whipple’s procedure, experiencing nausea, loss of appetite, malabsorption due to pancreatic enzyme insufficiency (PEI) and delayed gastric emptying.
Nutritional needs: Higher protein and energy intake requirements due to surgery recovery, and PEI malabsorption. Vegan dietary preferences due to ethical reasons; therefore, very important to their beliefs.
Challenges: Limited hospital menu options for plant-based nutrition, reliance on food from family and friends to aid nutritional intake, and sample orders for plant-based ONS, as this was not in the hospital inventory.
Outcome: A plant-based smoothie ONS was introduced to increase energy and protein intake, plus food from family and friends, and soya-based snacks. In the outpatient setting, gradual dietary adjustments were made alongside pancreatic enzyme replacement therapy (PERT) titration.
This case highlights the need for improved accessibility and availability of plant-based meals and ONS in clinical settings to meet patient demands effectively.
Despite the growing uptake of vegan or plant-based diets, there are still significant challenges for meeting their nutritional needs in the clinical setting.
Higher energy and protein requirements: Many plant-based hospital menu options are lower in calories and protein compared to their animal-based counterparts. Often, they don’t provide snacks or deserts that are vegan, other than fruit or fruit salad.
Limited ONS availability: The majority of standard ONS are dairy based, leaving patients with no suitable alternatives.
Reliance on family and friends: Patients often depend on family or friends to bring food in for them to meet their nutritional needs. This puts pressure on the family and friends and is an additional cost burden. Furthermore, they’re limited on what they can provide as clinical settings do not allow food to be re-heated.
Consequences of inadequate options: If patients do not receive sufficient energy and protein, they face sub-optimal intake, weight loss, delayed recovery, increased length of stay, and an increased risk of malnutrition.
Although plant-based ONS offer potential benefits, research in this area is limited. Key gaps include:
Effectiveness of plant-based ONS in exclusive enteral nutrition (EEN) for Crohn's disease: Standard ONS are used for EEN, but no research currently exists on whether plant-based ONS could be equally effective.
Tolerance and efficacy in gastrointestinal conditions: Would plant-based supplements be better tolerated in specific conditions such as gastroparesis or non-alcoholic fatty liver disease?
Comparative nutritional outcomes: More studies are needed to assess whether plant-based ONS provide comparable long-term benefits to traditional dairy based options.
To ensure optimal patient care in a growing population, dietitians and healthcare professionals must advocate for greater accessibility of plant-based nutritional support, including ONS, snacks, and expanding the menu.
Due to the increasing demand for plant-based options; the plant-based ONS should be stocked in the clinical inventory and be used as part of your dietetic toolkit
Patients with conditions like IBD, IBS, and coeliac disease may prefer and benefit from plant-based nutritional support.
Limited hospital options lead to sub-optimal intake, impacting recovery and overall health.
More research is needed to validate the efficacy of plant-based ONS in clinical applications.
Healthcare professionals should work towards integrating plant-based ONS as a standard, accessible option for all patients.
AYMES is leading innovation in plant-based clinical nutrition with its Actagain 1.5 Plant Powered ONS. This product is:
Nutritionally complete and based on faba protein (a soya-free option for those with allergies or intolerances).
Available in three flavours (Madagascan Vanilla, Café Latte, and Salted Caramel), providing 300 kcal and 13.4g protein per serving.
Sustainably packaged in Tetra Pak cartons to reduce environmental impact.
Additionally, ActaSolve Smoothie offers a plant-based powdered alternative that can be mixed with water, providing flexibility for different patient preferences and needs.
