The Benefits of Blended Diets for Tube Feeding
Did you know that research has shown that in many regards, blenderized tube feeding is a superior option compared to commercial formula? In this blog post, I’ll be reviewing the known benefits of blended diets for tube feeding based on the available published research. I hope you’ll find this information helpful in your tube feeding decision making.
Blended Diet Benefit: Better Diet Quality
This is the one "benefit" for which I cannot present any specific studies that have researched this particular aspect of blended diets, however, I think it is the most obvious benefit of them all. By including fresh food in a tube fed diet, the tube fed individual can experience the health benefits of a diet composed of whole, unprocessed foods. There is plenty of data that supports the benefits of whole food diets for oral intake, and there is really no reason to think that the benefits would be any less for people who are tube fed. With blenderized tube feeding, a person's diet can contain antioxidants, probiotics, probiotics, natural fibres etc. While there are options for whole food based tube feeding products, I'm not convinced that any packaged food can contain the same quality diet as homemade blends based on fresh food.
Blended Diet Benefit: Tube Feeding Tolerance
Blenderized tube feeding appears to be better tolerated than standard tube feeding formula. Why? I’m not completely sure to be honest. Studies have shown that people generally feel better and have less reflux when using blended food for tube feeding. In my experience working with tube fed adults, I see people having less nausea and “upset stomach” when using blended food rather than commercial tube feeding formula. I suspect this is due to the fact that blended food typically doesn’t have high concentrations of sugar like standard tube feeding formula. Taking in large amounts of sugar can be tough on the stomach if you’re not used to it (I know this from firsthand experience- read about my 3 day tube feeding formula challenge here).
I’ve worked with patient who struggle to tolerate relatively low formula infusion rates, but once on a blended diet, they can manage to have bolus feeding. This can be a huge benefit for many people. We all deserve to have nutrition that makes us feel good, whether or not we are tube fed.
Below, if you’re interested, you can read a summary of the available research on this topic:
In a study lead by Dr. Pentiuk and published in 2011, 33 G-tube fed children were changed from standard enteral formula to BTF for a 2 month period at home. These children had previously had fundoplication surgery (a procedure to reduce reflux), but continued to suffer from persistent retching and gagging while receiving standard tube feeding formula by G-tube. After changing from standard formula to blenderized tube feeding, twenty-four children (73%) had at least a 50% decrease in gagging and retching. Over half the children had a 76%-100% reduction in gagging and retching symptoms. No child experienced worsening of symptoms on a blended diet. These findings suggest that a blended diet by G-tube is better tolerated than standard formula in tube fed children with persistent gagging and retching symptoms after fundoplication surgery.
In a recent prospective study by Kelsey Gallagher (a Canadian dietitian!), 20 “medically complex” G-tube fed children (aged 1-16 years) were changed from standard tube feed formula to blenderized tube feeding for a 6 month period at home. The children experienced less vomiting, less gagging and/or retching and required less antacid medications after the change to a blended diet. What do these findings mean? The children had better tube feeding tolerance on a blended diet compared to when they were on formula.
A recently published study conducted by pediatrician Dr. Batsis also found improved tube feeding tolerance with blended diets. While on standard enteral formula, 21 of 23 tube fed children experienced upper gastrointestinal symptoms including gagging, retching, and emesis. Three months after initiation of a blended diet, 95% of the children had improvements in those symptoms.
The same results were found in a 2018 survey of 433 parents of tube fed children. Parents reported their children had less nausea, vomiting, bloating, pain and diarrhea on BTF compared to commercial formula feeding (this was a study conducted by Theresa Johnson RD).
Most of the research on tolerance of blended diets has focused on children, but there are studies which have focused on adults. In a survey study of home tube fed adults, respondents reported a reduction in symptoms of gas/bloating, diarrhea and constipation when on a blended diet compared to standard tube feeding formula (this study was conducted by Dr. Ryan Hurt, a physician at the Mayo Clinic).
Blended Diet Benefit: Intestinal Microbiome Diversity
This one sounds complicated, but it’s actually pretty simple. We have trillions of bacteria who live in our gastrointestinal tract. Don’t worry! This is perfectly normal, in fact, these bacteria have many important functions in our digestion and absorption of the food we eat. The bacterial rely on us for their food. Their food is our food. Research suggests that it’s a good thing to have a wide variety of different bacterial in the gastrointestinal tract. Diversity appears to be linked to better health. If your diet contains a variety of foods (blenderized tube feeding gives this option!), then you are more likely to have a variety of different bacteria in your bowels. Different bacteria have different preferred energy sources, so if you have a diet including lots of different foods, you’re going to make lots of the bacteria happy as they will likely find their favorite food passing by in your gastrointestinal tract. People who consume only standard tube feed formula have no diversity in their diet, so they lose the diversity in their intestinal bacteria (bacteria die if they are starved of their food source...many need plant fibres in particular, so fibre free formula would not provide them with what they need to survive). This is not a good thing. So, blended diets better support a healthy and diverse bacteria population in the gastrointestinal tract, compared to formula, as shown by the study described below:
The study conducted by Kelsey Gallagher RD and her team (described briefly above in the tolerance section) also looked at the intestinal microbiome of tube fed children before and after starting a blended diet. 20 medically complex tube fed children were changed from formula to a blended diet for a 6 month period. At the end of the study period, the children’s stool was analyzed and it was found that they had improvements in the composition of their intestinal microbiome. They had more species diversity and decreased proteobacteria (these are considered “bad” bacteria). Their findings suggest that whole foods and diversity of the blended diet lead to this positive change.
Blended Diet Benefit: Improved Oral Intake
There’s not a lot of scientific evidence for this one, but many parents insist that using a blended diet for their child’s tube feeding has helped with the transition to eating by mouth. In fact, in a survey of parents of tube fed children, it was found that one of the reasons parents opt for BTF for their children is because they believe that it may speed their transition to an oral diet. (Reference: Johnson et al. Reemergence of blended tube feeding and parent’s reported experiences in their tube fed children. J Altern Complement Med. 2018;24(4):369-373.)
There are three studies of tube fed children which found that oral intake may improve with BTF. Dr. Pentiuk found in his study that 57% of the children fed a blended diet by G-tube increased their oral intake after the change from formula to blended. Likewise, in the study conducted by Kelsey Gallagher RD, 67% of participants were reported to have some degree of oral intake when being tube fed commercial formula at the start of the study. Then, after using blenderized tube feeding for 6 months, 80% of the children were eating by mouth in variable amounts.
In a recent study of 23 tube fed children who transitioned to a blended diet, 53% had improved oral intake after 3 months. (Reference: Batsis et al. Efficacy and tolerance of blended diets in children receiving gastrostomy feeds. Nutr Clin Pract. 2019)
Blended Diet Benefit: Positive Feelings
It appears that there are psychological benefits to having a blended diet for tube feeding rather than (or in addition to) commercial formula. These include the ability to share meals with loved ones and enjoy a diet that reflects personal preferences and culture.
When adult enteral nutrition clinic patients were surveyed in regards to their use of blenderized tube feeding, the most prevalent reasons for choosing a blended diet was that it allows them to eat what their family is eating and makes them feel “normal” (Study by Dr. Hurt et al, 2015 ). Likewise, in a survey of parents of tube fed children, one of the reasons for a blended diet was to provide family foods (Johnson et al, 2018). In a prospective study of G-tube fed children, 94% of caregivers agreed that their child appeared happier after changing to a blended diet (Gallagher et al, 2018).
Blended Diet Benefit: Lower Cost
Lastly, a blended diet is a less expensive option in situations where government funding or insurance reimbursement does not cover the cost of commercial formulas.
The daily cost of homemade blenderized tube feeding diets averaged 5 USD as compared to 14 USD daily for commercial formula in a study conducted in Brazil (Viera et al, 2018). In another Brazilian study, it was found that compared to commercial products, a blended diet is on average 70% less expensive than commercial formula (Bento et al). These findings echo the cost analysis included in an article written by Walia and published in the Journal of the Academy or Nutrition and Dietetics in 2016. Blenderized tube feeding was found to cost $3.60 US per 1000 calories, while standard commercial formula was $8.50 US per 1000 calories. That's quite a big difference and would certainly add up over time!
Thinking About Trying a Blended Diet?
If you're thinking about trying a blended diet for yourself or your loved one, make sure you talk to the health care team before making the transition. Although a blenderized tube feeding offers many benefits, it takes more time, planning and work compared to commercial formula. Plus, if your blends aren't properly designed, there is a risk of nutritional inadequacy. This is why it is imperative to get the support and guidance of your health care team. If you're looking for easy nutritious recipes to help get you started, I've got you covered. Check out the Natural Tube Feeding Recipe eBook here. It takes the guess work and stress out of blending as the blends are nutrient dense, balanced and the right texture for tube feeding...making it a great resource for a successful transition to a blended diet.
Thanks for reading!