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by Peter J. Nebergall, Ph.D.

We're always concerned with what we can, can't, should, and should not eat. We pass by the shelf, and in big, bold letters it says "For Diabetics!" Is it? Should we add this one to our meal plan? What about that one? And so on ...

From Slimfast on down, there are a lot of liquid "meal replacers" out there. All have carb counts; some have diabetic exchanges. Strictly speaking, you can factor such a product into your meal plan. Should you?

Be careful. All of the ones I looked at: Slimfast, Ensure, Ensure Plus, Ensure Glucerna, CarboRite At Last, Diabetic Care Choice, and Enterex Diabetic, are "loaded" foods. Designed to provide a meal's nutrition, they are full of protein, carb, fat, and vitamins. If you have nothing else to eat, they can keep you alive. Used under close supervision, they'll do what they say they'll do -- help keep you slim, properly fed, and well nourished. But there's a problem -- and it's not with the products -- it's with us.

In America, we're accustomed to reaching for food because we feel like it, and eating 'til we're full. Undisciplined snacking. It's dangerous. It's why we're the fattest nation on the planet. It's the "see-food" diet.

What's wrong with treating a can of Glucerna, or a container of Diabetic Care Choice, as an impulsive snack? Lots. For starters, there's 290 calories in that can; 100 of them from fat. That's not a snack; that's your lunch! If you start chugging Slimfasts, you'll go the opposite direction, like: fatfast. If you're going to "eat 'til you're full," don't be using these -- as you can run up 500+ calories before you even notice. If you're a "nervous eater," I don't think you should keep this stuff in your house.

What should you do with them? What is their niche? All of them are carefully-formulated, medically-tested, high-quality, and generally free from trendy, untested "alternative" ingredients. Ensure and Ensure Plus are meal replacers originally formulated for people without diabetes, who need to follow a liquid diet, for sustenance. Ensure Plus has more calories, and is more "fortified." Though they are not optimal for diabetics, both are packaged with sufficient information that someone using the "carb counting" system could work them into a meal plan.

Slimfast, again not originally formulated for diabetics, was derived as a "meal replacer" for weight loss. If you read the contents, though, it's not that different from Ensure, and Slimfast is labeled for both carb counting and the older "Exchange System." Like Ensure, Slimfast comes in a variety of flavors, and generic equivalents are available in big chain stores.

Ensure Glucerna is similar, but specifically formulated with the needs of diabetics in mind. There is less sugar. But, as diabetic diet management is not the avoidance of sugar but the management of a total budget of carbohydrates and calories, the avoidance of sugar is nice, but of incremental value.

Diabetic Care Choice and Enterex Diabetic are similar to Glucerna. Diabetic Choice, from Bristol-Myers Squibb, comes in a package, not a can, and has slightly fewer calories than its competitors -- but the package is smaller. (The Diabetic Care Choice line also includes snack bars, skin creams, and excellent "diabetic socks.") The idea, according to Bristol-Myers Squibb, is to use this product as a snack replacer, rather than a meal replacer. Still, that's more a difference in use than in formulation.

CarboRite At Last, from CarboLite Foods, is a bit different, a bit more trendy. Billed as a "low carb nutrition shake," it makes use of the excellent non-sugar sweetener Splenda. Heavily vitamin-fortified, this drink contains chromium (the link between chromium and diabetes has never moved beyond "pop science") and a natural additive they are calling "insulade." Please remember science is not a religion; there is a difference between what is medically tested and what some "alternative people" choose to believe -- it's your body; be careful what you put in it.

Enterex Diabetic, by Victus, of Miami, Florida, is very low in sugar, but otherwise is, like the others, a meal-replacement drink. Like At Last, it also sweetens with Splenda, and that is commendable. Like the others, in my opinion its taste would not pass muster at the soda fountain -- but none of these is intended for dessert.

These products are not "medicine." Simply consuming them will not heal you of diabetes, or even cause you to lose weight. The "D" in the word "diet" is the same as the "D" in the word "discipline," you should remember. You have to get your eating under control, and replace something excessive with one of these instead. As part of a disciplined, medically supervised meal plan, they'll help you. I can't improve on the statement printed on every can of Glucerna, so here it is:

"Use under medical supervision as a meal replacement for dietary management of diabetes. Consult your health care provider for a weight-loss goal, calorie level and blood glucose monitoring schedule that is appropriate for your nutritional needs, blood glucose management goals, and daily activities ..."


CarboLite Foods
Evansville, IN 47715

Bristol-Myers Squibb
New York, NY

Ross Products Division
Abbott Laboratories
Columbus Ohio
1-800-986-8589, 1-800-986-8727

Victus Inc.
Miami, Fl.