Frequently Asked Questions
Some private health insurers include funding for a consultation with a dietitian, but this depends on your insurance healthcare plan. If you have private health insurance you should contact the company directly to see what is included in your plan.
If funding is included in your plan, some insurers will have a payment cap on the amount the insurance company will pay for each dietitian consultation. If this payment amount is less than the price of the consultation, the deficit amount will need to be paid by the client. However, some private health insurers will not allow clients to pay the fee deficit and to do this would breach the terms and conditions the dietitian agrees to, to become a recognised service provider with the health insurance company. This can sometimes mean that private dietitians are not always willing to see clients funded by all healthcare insurance companies.
Please let us know when you book a consultation if the consultation fees will be funded by your private healthcare company. If you have cover to see a private freelance dietitian you will need to get pre-authorisation from your healthcare insurer company prior to your consultation.
We are currently registered (have provider recognition) with the following healthcare insurance companies:
Aviva
AXA
Vitality Healthcare
If your appetite has decreased and you are eating much less, or you have lost weight unintentionally, you may need a referral to see a dietitian (working within the NHS). You should first advise a health professional at your GP surgery or within your specialist respiratory team of any nutritional issues you are having. They should be able to carry out nutritional screening to help determine if you are at risk of malnutrition. If you are considered at risk of malnutrition your health professional will follow local nutrition treatment guidance. This may include prescribing nutrition supplement drinks and/or referring you to see a dietitian for more individualised dietary advice.
Vitamin and mineral supplements
There are a huge selection of vitamin and mineral supplements available to buy as well as other dietary supplements derived from spices, herbs and other food substances. Vitamins and minerals are essential nutrients we get from the foods in our diet. They are needed in small amounts and are collectively known as micronutrients. For more information on micronutrients see our ‘Learn More’ pages.
When it comes to dietary nutrients, more does not equate to better and instead very high doses of certain nutrients can be harmful to health. It is important to understand that taking a vitamin and mineral supplement is never a substitute for eating a healthy balanced diet.
However, some groups of people may benefit from taking additional vitamins and minerals:
• Those with greater vitamin and mineral needs due to age, medical conditions or illness
• Those avoiding specific food groups such as dairy (and not taking fortified plant based alternatives)
• Those who have a poor appetite and a reduced food intake
• Those who follow a vegan diet but do not get enough of all the essential nutrients they need
• Those at high risk of vitamin D deficiency
Other dietary supplements derived from spices, herbs and other food substances
Other dietary supplements will often have medical and health claims but not all are backed up by scientific evidence. Medications require rigorous testing before they can be licensed, to ensure they have no long term harmful effects. Something that is considered a ‘natural’ food substance does not require the same rigorous testing before it is available to be sold. If the dietary supplement contains a food substance in unnatural amounts (more than would reasonably be eaten in one day), it would be wise to look at the scientific evidence behind health claims in more detail.
Advice before starting vitamin, mineral or other dietary supplements
• Do not take them to treat a health condition unless you have been advised to by your medical doctor.
• Always buy them from a reputable source such as your local chemist, pharmacy or supermarket rather than an unknown company on the internet.
• Avoid mega dosing. More does not always mean better! For essential dietary nutrients always check the supplement does not provide more than recommended amounts.
• Research health claims by looking at the scientific evidence or talking to a registered health professional.
• Talk to your pharmacist or doctor before starting any supplements as some can have interactions with medications or are unsafe if you suffer from certain medical conditions.
• If after discussion with your health professional, you decide you need to start taking a vitamin and mineral supplement, choose one that contains the complete amount of all the essential vitamins and minerals.
• Do not take multiple vitamin and mineral supplements together (unless you have been advised to do so by your doctor).
• Be aware that taking too much vitamin A is not good for us. If you are taking a vitamin and mineral supplement containing vitamin A, in addition to other supplements containing vitamin A (e.g. some fish oil supplements), you will be taking too much. If you regularly eat liver (weekly), which is very high in vitamin A, you should not take additional supplements containing vitamin A.
Further resources
The British Dietetic Association (BDA) has a good resource on supplements which can found online by searching for ‘BDA supplements’. More information on vitamins and minerals can also be found on the NHS UK website.
For the answer to this question see our ‘Learn More’ page on vitamin D.
Prescribable nutritional supplements are ACBS approved. ACBS stands for Advisory Committee on Borderline Substances and is the body that is responsible for advising health professionals on the appropriate prescribing of non-medicines. ACBS review each nutritional supplement and the scientific evidence to justify its clinical use. For every nutritional supplement the ACBS approve, they stipulate the clinical condition it can be prescribed for. For those with respiratory conditions, unless there are other medical issues, the criteria for prescribing nutritional supplements will be: ‘for the treatment of disease related malnutrition’. Your health professionals will not be able to prescribe nutritional supplements unless you have been identified as malnourished or at high risk of malnutrition by nutrition screening. However, malnutrition treatments depend on local guidance, which means some GP’s have restrictions on the type and number of nutritional supplements they can prescribe.
The National Institute of Clinical Excellence (NICE), is an organisation who provide recommendations on appropriate treatments and care within the NHS. NICE Clinical Guideline 115: Chronic Obstructive Pulmonary Disease (one of the most common respiratory conditions) recommends: “for people with a low BMI, give nutritional supplements to increase their total calorific intake and encourage them to exercise to augment the effects of nutritional supplementation”. However, using only Body Mass Index (BMI) to determine malnutrition does not identify those who have malnutrition but are not under weight. This is discussed in more detail in our ‘Learn More’ pages.
If you are worried you are not eating enough and need nutritional supplement drinks prescribed, you should discuss your concerns with your health professional. They should be able to advise you on what you can do and if you meet the criteria for prescribing nutritional supplement drinks. They may refer you to a dietitian for an individualised nutrition assessment first. Dietitians and other health professionals often use a ‘food first’ approach. This is where they give advice on ways to improve nutritional intake by swapping foods and drinks for more nutritious ones containing more energy, protein and nutrients. Using this approach instead of prescribing nutritional supplement drinks will depend on several factors and ideally some form of dietary assessment should be done first. Individualised dietary advice is intended to be a more long term solution for people with chronic health issues.
Nutritional supplement drinks were prescribed for me while I was a patient in hospital…
Sometimes you will have been prescribed nutritional supplement drinks while you were in hospital because you were unwell or recovering from surgery and not eating enough. You either had signs of malnutrition or were considered at high risk of developing malnutrition if your nutrition needs were not met. As food and snack choices are often restricted in hospital, nutritional supplement drinks are often considered an easier short-term solution to supplement nutrient intakes.
If you were provided with some nutritional supplement drinks to take home on discharge from hospital, you should also have been given some dietary advice and been advised what you should do if your appetite did not improve. If you were seen by a dietitian while you were in hospital they should have advised your GP when you were discharged home if they thought you needed to take nutritional supplement drinks longer term.
Contact your dietitian or health professional for further support if your appetite remains reduced or your weight continues to reduce after you have been discharged from hospital.
Firstly it is important to understand that prescribable nutritional supplement drinks are not just drinks! They are nutritional supplements, containing essential nutrients to treat malnutrition and improve your health. You should know that they have been prescribed for medical purposes and so if you can, try to think of them as a medicine.
Most people find them much less palatable when warm, so if possible serve them cold, straight from the fridge and don’t let them sit for too long at room temperature. Health professionals often advise sipping nutritional supplement drinks slowly throughout the day but if you do this they warm up and become much less palatable. If you are unable to drink the entire bottle or carton in one go, keep it in the fridge and split the drink into 2-3 manageable ‘medicine’ amounts to serve at suitable intervals during your day.
Alternatively make them into something else you can manage. You can use them to make a warm milky coffee or malted milk drink, fruit smoothie, milk jelly, milk based pudding or add to a savoury dish. Or instead try them frozen as a slushi or as a fruit ice lolly. Most of the nutrition companies will have recipe booklets on how you can do all these so ask your dietitian or other health professional for further information.
What is it that you don’t like about them? Try the following tips to see if these can help you…
I dislike the flavour
Each type of nutritional supplement drink will come in a variety of flavours. Many people only like one or two of these flavours so make sure you try the flavours before getting them in large numbers on prescription. If you only like certain flavours make sure your GP specifies these on the prescription. If your GP has already done this for you and your local pharmacy or pharmacy delivery service gives you alternative flavours that you do not like, you should not accept them as they cannot be returned after being issued to you.
They are too sweet
If you are finding them too sweet add a little milk or a plant based milk alternative such as unsweetened soya milk to help reduce the sweetness. Or try alternative flavours that you might find less sweet such as mocha or vanilla. Some nutrition companies have natural or plain flavoured nutritional supplement drinks which tend to be much less sweet. Ask your dietitian or other health professionals about the alternative flavours available and how you can go about trying these.
It’s the aftertaste I don’t like
Some people find they get an unpleasant aftertaste after drinking a nutritional supplement drink. This can be related to the vitamin and mineral content. If you find this is an issue, try rinsing your mouth with cold iced water after drinking or alternatively suck on an ice cube or boiled sweet. Remember try to think of nutritional supplement drinks as a medicine and persevere in taking them as prescribed if you possibly can.
I do not like milky things
You will often be prescribed milk based nutritional supplement drinks as they have a more suitable nutrient content and tend to be more palatable. There are juice based nutrition supplement drinks available on prescription but these are not nutritionally complete and tend to be much lower in protein. If you can only manage the juice based nutritional supplement drinks you will need to make sure that your protein needs are met with other high protein food sources otherwise your malnutrition will worsen. There are other prescribable nutritional supplements that contain just protein but these should only be prescribed after a full dietary assessment by a dietitian.
I’m worried they may upset my tummy
Getting a milk allergy as you age is unusual but increasing your intake of milky drinks when you don’t usually drink lots of milk could give you an ‘upset stomach’ and/or make your stools (poo) looser. This is not usually because you have developed an allergy to milk, it is more likely because you have lactose intolerance. Milk contains lactose and you need an enzyme called lactase in your gut to digest (break down) lactose so the milk sugars can be absorbed. Some people have lower amounts of this enzyme in their gut so when they start introducing lots of milky drinks (or some other dairy foods high in lactose) into their diet, the undigested lactose can travel further down into the colon (lower gut) and cause symptoms such as diarrhoea, wind, bloating and tummy pain. Most people with lactose intolerance are able to follow a low lactose diet rather than having to completely avoid milk and milk products.
Nutrition companies that make nutritional supplement drinks are very aware that some people have a degree of lactose intolerance so many of the milk based nutritional supplement drinks contain only low amounts of lactose and can be tolerated unless you usually follow a milk free diet. Your health professional will be able to check this for you. If you do experience new symptoms when you start taking nutritional supplements you should contact your health professional for further advice. For more information on lactose intolerance you can go to the Allergy UK or NHS websites.
Remember prescribable nutritional supplement drinks are prescribed to treat malnutrition. They are expensive and add significant cost to NHS budgets. They cannot be returned or given to anyone else once they are dispensed by a pharmacy. Therefore if you are really unable to take them as prescribed do not continue getting repeat prescriptions for them and instead seek advice from your dietitian or other health professional.
For the answer to this question see our ‘Learn More’ page on protein.
If you have a nutrition question…
We hope you can find the answer to this in our FAQ or ‘Learn More’ pages. If not we encourage you to message us your questions using ‘Contact Us’ at the bottom of every page. We cannot promise to answer all questions personally but we want to keep adding to our FAQ and ‘Learn More’ pages, so if we get lots of requests for a particular topic, we will add this to our website. We also present nutrition topics on our YouTube and Instagram channels.