Enteral nutrition feedings (EN) save lives and help patients maintain their weight and nutritional status when eating by mouth is not possible, sometimes for long periods of time. However, many patients complain about the flavor (when regurgitated) and the medicinal nature of the feedings. Mark was a patient at our local cancer center who was unable to take foods orally, and he asked for alternatives to the typical processed tube feeding. He wanted meals with his family and similar foods to what they ate, so his wife considered blending home meals.
Typical tube feedings available to consumers and hospitals are standardized enteral feedings (EN) with hard to pronounce, formula ingredients that provide calories and the nutrition needed to maintain or improve health, but little more. With the rise of organic and natural foods, consumers, including those needing to be fed by tube are looking for a more wholesome option made with real foods. Families are exploring options such as home blenderized meals and new to the market, commercially prepared food–based tube feedings and meal replacements. So, standardized feedings are not the only option.
Home blenderized foods can contain naturally occurring antioxidants, phytochemicals, and may be ideal for the person with allergies and intolerances. With the addition of vegetable sources of fermentable fiber, these can foster healthy bacteria and digestion. However, with home blenderized feedings, some risks are involved including potentially unbalanced nutrient levels and thus inadequate intake, microbial contamination, and the potential for clogged tubes. Almost any food can be blended if care and proper handling techniques are used. Understandably, some foods are more difficult to blend, such as stringy foods like celery and asparagus, but also nuts, seeds, cheese, and corn. If nuts are desired, a smooth nut butter is an option, but it must be blended with liquids for the right consistency to prevent clogging the feeding tube. Other healthy fats such as avocados, and olive or flax seed oil can help increase calories when necessary. Another option is using jars of natural baby foods. Blended foods should be used within 24 hours or be discarded. Flush tubes before and after feedings.
Several commercially-prepared, food-based options are now available. One such option is similar to other standard formulas with highly processed ingredients, additives, and preservatives in addition to food powders and purees. A second option is made with real foods but it is not nutritionally complete, and it is intended to complement the daily tube feeding rather than be the sole source of nutrition. A third option, on the market for four years with a new pediatric line, is made from nutritionally complete organic whole foods with no added sugar, chemical preservatives, dairy, soy, corn, or gluten.
For those individuals looking for alternatives to commercially prepared EN, more options are available. Which one to use should be considered carefully with the help of an RDN to make sure the choice is suitable for the families’ expectations, budget, level of commitment, schedule, level of sanitation, and cooking facilities.
By Sarah Laidlaw, MS, RDN, CDE
Resources:
Real Food Blends: Meals for Tube Fed People. http://www.realfoodblends.com/for-dietitians/ Accessed April 11, 2017.
COMPLEAT. https://www.nestlehealthscience.us/brands/compleat/compleat-hcp. Accessed April 11, 2017.
Liquid Hope and Nourish. Functional Formularies. http://www.functionalformularies.com/ Accessed April 11, 2017.
Zelman, K. The risks and benefits of DYI blended tube feedings. Food and Nutrition Magazine. Available at http://www.foodandnutrition.org/July-August-2016/. Accessed April 13, 2017.
Disclosure: Sarah Harding Laidlaw, MS, RDN, CDE is a brand Ambassador for Functional Formularies, maker of a whole food, organic, blenderized enteral feeding.