I recently had a wake-up call. I have been practicing as a dietitian for 25 years, of which over 20 years I’ve been championing the use skimmed milk powder along with double cream in food fortification for individuals at risk of undernutrition. It is a match made in heaven; milk powder provides the protein, double cream provides calories and it tastes wonderful mixed into porridge, milk puddings, custard and soup.
I work predominantly in care homes delivering a service called ‘Focus on Undernutrition’, which provides training and support to homes on the identification and treatment of undernutrition, including providing training on fortified diets and drinks. For years when working alongside cooks I have seen various catering size bags of milk powders, whether it be own brands from Brakes, Bidvest, Country Range or Milac milk powders, I assumed they were all the same, providing 5g protein per heaped tablespoon (15g). If people asked what milk powder they should use, I always said, any skimmed milk powder, they are all similar (or so I thought); this is where my wake up call started…
I recently was horrified to discover there is actually a huge difference in the protein content of skimmed milk powders. As a dietitian, I did not appreciate most skimmed milk powders have been adapted to include added vegetable fats which can significantly impact the protein content. Imagine my horror when I realised most commonly used milk powders in care homes only provide between 1.8-1.9g of protein per tablespoon. The only skimmed milk powders which provided the 5g I expected were the full dairy milk powders, which provide up to 5.5g protein per heaped tablespoon.
Since my discovery, I have spoken to several colleagues who likewise, did not realise that there was actually a difference in the types of skimmed milk powder; full dairy versions (which are high in protein) and added vegetable fat version (which are significantly lower in protein).
As a dietitian the only reason I promote skimmed milk powder is that it is an amazing source of protein; I think of it as the unsung hero in the food world. It is so simple to incorporate into dishes and drinks, it doesn’t negatively impact the taste and is widely available. However, when I work in care homes I get so saddened because of confusion because care home staff often truly believe they are fortifying their dishes to help their residents, but I fail to see the evidence in resident’s weights. When I investigate, I discover they are only fortifying with extra cream or adding extra cream and milk powder but in such small quantities, it is unlikely to make a significant difference to residents.
As a dietitian I am a strong advocate of food fortification, but that should always be calories, protein and other nutrients, which should only be given to residents who have been identified at risk of undernutrition. I have always recommended when fortifying dishes each serving should be fortified with one heaped tablespoon of skimmed milk powder mixed with two tablespoons of double cream, which provides an additional 180 calories and 5g protein. Ideally, a heaped tablespoon (15g) of skimmed milk powder should provide around 5g protein and 50 calories. Milk powder is not also a great natural source of protein, it also is a good source of calcium, vitamin B2, Vitamin B12, potassium, phosphate and iodine, so enabling the fortifying of other nutrients as well.
Fortifying milk is also another great way of obtaining additional protein; 5 heaped tablespoons to one pint of milk, will provide an additional 250 calories and 25g protein. This may make the milk slightly creamier, so fortified semi-skimmed tastes more like full cream milk, and fortified full cream milk tastes more like Jersey cream milk. If people find fortified milk too creamy I recommend fortifying the milk category below the one they currently use so it will taste similar; for example, if currently using full cream milk, fortify semi-skimmed milk because nutritionally the fortified semi-skimmed milk will be far superior to standard full cream milk. If someone is losing weight I recommend them to try to use a pint of fortified milk daily; which is easy to achieve, for example, if used on cereal/porridge, a milky coffee/hot chocolate and four cups of tea.
In my dietetic experience, the reason most care settings use skimmed milk powder is to enhance the protein levels of food dishes and drinks. In care settings where full dairy skimmed milk powder is available through suppliers why would a company use a vegetable based milk powder when it provides only a third of protein per tablespoon to a full dairy version. The full dairy skimmed milk powder 2kg bags may at face value seem more expensive, but that is a total misconception. To achieve the same amount of protein using a standard added vegetable fat skimmed milk powders you would need to use three times the amount. Realistically that is not achievable or palatable and more expensive. For example, using three heaped tablespoons of standard vegetable fat milk powder in one serving of custard/milk pudding compared to one heaped tablespoon would significantly impact the consistency and taste of the dish to achieve the same amount of protein, whilst being potentially be unpalatable.
So, will I change my practice as a result of these lessons learnt? Now I am aware that not all skimmed milk powders are the same nutritionally, as a dietitian I will be recommending the use of a full dairy version when they are available.