The Best Way to Make a BD: Choosing Your Menu
Actually, the title of this sub-section is a misnomer. There is no 'best' way to make a blended diet. You need to make foods that work the best for you and your situation. The great thing about BD is that it can be tailored to the individual. We've included a few recipes on this website, but they are merely examples to inspire you and give you a place to start when adapting your own diet. Our advice is that you read the rest of this section, the section on blenders, and the section on the mechanics of tube feeding and get the proper materials and knowledge at hand before you dive in and start mixing.
It's important to note that it is ok to mix real food with the formula you are currently taking. However, you should also be aware that if you are switching to a BD because you can't tolerate your commercial formula, this won't change just because you're adding in real food. In fact, if your body is having a difficult time digesting formula, it may have an even harder time with blended nutrients on top of formula. Commercial formulas are complex products with an unnatural mix of ingredients that may be stretching your digestive system to its limits. Adding another food could overload your system, and you may conclude that the added food is the problem, rather than the complicated mixture of foods. If you're going to try BD, then we recommend you replace formula with a mix of real foods thinned with water or another liquid that you know your body will tolerate.
When constructing BD, you should be cognizant of getting the proper amount of calories, fats, carbohydrates, protein, dairy, fruits and vegetables, in consultation with your doctor and/or nutritionist. A good technique is to create a daily menu that has portions from each group of these nutrients in it. Over time, you can vary the ingredients within the groups. So, you might change out which vegetable you blend or the source for your protein. The most important rule for this technique is that you have an overarching goal for your nutrition. If you want a minimum of two servings of fruit and five servings of vegetables, you should plan your meals accordingly. Decide if you will try to make each meal 'complete' with a balanced blend of each necessary ingredient or if you will aim for reaching your nutrition goals at the end of a 24 hour period (e.g. make a primarily 'fruit' blend in the morning and a mostly 'vegetable' blend in the afternoon).
As you know, there are countless diets to choose from. With a high-end blender, like the Vitamix, you have a great deal of flexibility when making your meals. For the 'overarching nutritional goal' we mention above, we recommend you use the United States Department of Agriculture's (USDA) Choose My Plate approach (http://www.choosemyplate.gov, formerly known as the Food Pyramid) when blending your meals. The main idea here is that you would aim for 50% or more of your diet as fruits and vegetables, use whole grains as much as possible, and alternate the ingredients over time. The next section describes how MyPlate might work for you in practice.
Choose My Plate
To give you ideas for where you might start when planning your BD diet, we'll use choosemyplate.gov to build a daily menu using estimated amounts from each of the recommended food groups. We will then blend the meal and divide it up into individual feeds to eat throughout the day.
As I'm sure you've heard since childhood, whole grains are an important part of a well-balanced diet. This food group includes foods like wheat, corn, rye, oats, quinoa, rice, barley, and spelt. It also includes food made from these grains such as bread, crackers, pasta, oatmeal, grits, and cereal. You should shoot for a diet with at least 50% whole grains. Servings are measured by the ounce--e.g. one ounce equals a slice of bread or 1/2 of a cup of uncooked pasta.
All fruits fit in this category. They could be raw, cooked, fresh, dried, canned or frozen. 100% whole fruit juice falls in this category, but try to make sure at least half the fruit in your diet is fresh fruit. Fruit servings are measured by the cup and one cup of fresh fruit or fruit juice is the same as half a cup of dried fruit.
There is an incredible array of different vegetables to choose from. From leafy greens to dark green veggies (cabbage, broccoli, etc.), to red and orange colored (peppers, pumpkins, carrots), starchy vegetables (sweet potatoes, corn, potatoes), legumes (they could also count as proteins), and even mushrooms. There are so many great vegetables to choose from and now you can't use taste as an excuse not to eat them! Some vegetables can be eaten raw, some are best cooked; you can also use canned or frozen veggies. A good practice is rotating your vegetables by color so you get a good spread of this important food group. Like fruit, vegetables are measured by the cup. In the case of leafy greens, two raw cups is equivalent to one cup cooked.
You can get protein from any type of meat, nuts and seeds, processed soy products, and legumes. Like we said above, legumes like peas or beans can be used as a protein. If you use them as the protein portion of your meal, be sure you include other vegetables too. Alternatively, you could have meat as your protein source and add legumes for your vegetable. Protein is measured by the ounce. One ounce of meat or seafood equals 1/4 of a cup of cooked legumes, one egg, a tablespoon of nut butter, or 1/2 an ounce of seeds or nuts.
Dairy and Dairy Substitutes
This food group includes any type of animal milk plus all of the products made from the milk--as long as most or all of the calcium isn't lost. So, cheese, ice cream, kefir, and yogurt count as dairy while butter, cream and cream cheese do not. There are milk substitutes made from nuts or grains like almond milk and soy milk. They are fortified with calcium so they fall into this category. You don't necessarily need animal milk products as long as you ensure you get the missing nutrients--like calcium--in other ways. Discuss this with your nutritionist, as well as how much fat you want to get out of this food group. Dairy is measured by the cup, where one cup of whole milk or yogurt equals one and a half ounces of natural cheese or two ounces of processed cheese.
Take note of the amount of fats and oils you add to your blends. There are different views on how much fat should be included in our diets. Many tubies provide for a daily fat allowance, add a bit of extra fats and oils to their meal, then rotate through different sources to get the fat they need. If you blend foods that are already high in fat like certain meats or avocados or mayonnaise, then you wouldn't need as much added oil. Get your nutritionist's opinion on this.
Also try to avoid too many empty calories that come from refined sugar, hydrogenated fat, trans fat, or alcohol. These calories have no nutritional value. They can harm your digestion, cause a glycemic spike, or add unhealthy fat to your body. All of our junk food, processed food and fast food is made up of mostly empty calories. Soda cans are full of 100% empty calories. If you are completely tube fed, you gain nothing from putting soda through your tube. You don't taste it anyway and water will hydrate you far better. Some nutritionists may tell patients to increase their sugar intake to raise calories. However, we contend that there are far better, alternative ways of increasing calories.
Now that we've outlined the important food groups, let's see how much you would need to make up a 2,000 calorie diet. You can always make slight adjustments up or down depending on your needs. Here's a good daily guide to start with (taken directly from the USDA's ChooseMyPlate.gov site):
Grains: 7x 1-oz servings
Vegetables: 3x 1-cup servings
Fruits: 2x 1-cup servings
Proteins: 6x 1-oz servings
Dairy: 3x 1-cup servings
Oils, etc.: 6x tsp
Let's try a sample menu using this method for a 2,200 calorie diet.
Grains: 2 cups quinoa (450 cal), 2 cups oats (300 cal)
Vegetables: 2 cups spinach (80 cal), 2 cups sweet potatoes (230 cal)
Fruit: 1 mango (200 cal), 1 cup strawberries (50 cal)
Protein: 1 oz. almonds (160 cal), 5 oz. chicken breast (250 cal)
Dairy: 1 cup whole milk yogurt (150 cal), 1 cup whole milk (150 cal)
Oils: 3 tsp olive oil (120 cal), 3 tsp coconut oil (120 cal)
That comes out to 2,260 calories. How did we do with our portions? Looks like we chose to go a little lighter on the grains and dairy while adding extra veggies. Perhaps we could've left off some of the oil, or gone with a less calorie-dense grain than quinoa. This is something you can experiment with as long as you have a good, basic meal at the beginning and the right tools to work with.
You can divide out the meal above and have a 'breakfast' blend with mostly fruit, grains and dairy; then a 'lunch' blend with vegetables, almonds, and some oil; and a 'dinner' mix that would include the rest of the grains, protein, dairy and oil. You need to take ownership of your diet while ensuring it's well balanced! Over time, you will develop a routine and your own 'go-to' meals so you won't need to worry about adding up all the calories to make sure you're getting a properly nutritious diet.
If you find that you have specific food allergies (see the 'Foods to Watch out For' section below), you can adjust your Choose My Plate diet accordingly. If you're on a dairy-free diet, then substitute dairy with other foods. Just make sure you're getting a similar amount of fat, calcium, and protein that you would get with dairy in your diet. If you're a diabetic, or gluten-intolerant, or have a soy allergy, then adjust your meal plan accordingly. The beauty of blending real food is that it is extremely flexible as long as you speak with your nutritionist and/or doctor and use common sense.
If you are especially concerned about allergies or food intolerance, or if you have a compromised digestive system, it may be best for you to introduce your foods singularly, or through an elimination diet (see below). All you need to do is choose a food, blend it by itself with pure water, and see how your body tolerates it. Some good foods to consider blending and eating include bananas, apples, peaches, pears, plums, avocados, oats, rice, sweet potatoes, green beans, squash, peas, chicken, turkey, and beef.
Foods to Watch Out For
If you are introducing foods one at a time, or if you are concerned about potential allergic reaction to certain foods, there are certain foods you may want to avoid, or blend with caution. These include:
- cow's milk
- sesame seeds
- citrus fruits
It's best to eat these foods one at a time for four days each. This is called an Elimination Diet. In other words, try blending peanuts with no other potential allergens four days straight. If you have no bad reaction, then peanuts are safe and you can add them to your daily diet. Next, move on to another food--eggs--and try that out for four days. If you are especially concerned about your body's tolerance for certain foods, you may discover that you initially lose weight, compared to when you were on formula, as you slowly introduce potential foods to your diet. However, you will also find that you can tolerate much higher volumes of real food, so you can make up for the lack of calories in your diet by increasing your regular intake.
There is another group of foods you should be wary of. These foods have a reputation for thickening up your blend or not blending easily and should be used sparingly with an increased amount of water. These foods are:
- almonds or other tree nuts
- any grain that isn't completely cooked through
- sesame, sunflower, pumpkin, or flax seeds (the blades of the blender may miss some of the seeds so blend on high for 30 seconds to a minute longer than normal)
- blueberries (same as the seeds above)
- string beans (often get stuck around the blades of the blender)
- dairy (produces a large amount of foam while blending; the best remedy is to add the dairy at the end of the blend)
The question of special diets, once again, highlights the beauty of using a blended diet, rather than eating canned formula. You can be flexible with the ingredients of your meals depending on your needs. You also don't need to worry about how the food tastes, or whether or not you're getting the same ingredients, day after day. In a way, having a feeding tube is a benefit for those on a special diet (try to focus on the positives). There are some special dietary concerns we wanted to discuss here.
If you happen to have a j-tube (a feeding tube that bypasses the stomach and goes directly to your intestine), there are ways of making a blended diet work for you. J-tubes are not common for those with oral cancer, but it is possible you may have digestive issues that warrant this form of tube feeding. This is a case where it is crucial that you coordinate with your doctor and nutritionist. Most of those who eat through a j-tube are on continuous pump feeds. Therefore, you would need to keep your 'meal' cold while in the hanging bag so the food doesn't spoil. It's possible to do small bolus feeds, but nowhere near the volume you could quickly push into a g-tube. Also, if the food is going into the intestine, it needs to be somewhat digested. This is why j-tube users are normally prescribed elemental formulas. If you center your blend around juices, fortify it with protein powders, and blend it with your Vitamix to be thin enough to run through a pump, then this could mirror what you would get out of an elemental formula. The bottomline here is that other j-tube users have made blended diets work but talk to your medical team before you attempt it.
For those who are lactose intolerant or have an allergy to dairy, as we mentioned above, you should be able to easily cut dairy out of your blends. You need to be aware, though, that dairy from animal milk is an important part of a nutritious diet because it adds calories and protein. To make up for cutting dairy, there are plenty of options out there (rice milk, almond milk, soy milk, etc.) that are fortified with calcium and vitamins. Yet nothing has as many calories as animal milk, so you will need to add extra calories to your daily meals.
If you are vegetarian or vegan, there is no shortage of books, recipes, articles, and online assistance out there to help you plan your daily meals. You have the added benefit of not needing to worry about taste, so you won't necessarily need to go out and buy 'vegan sausage' because you miss the taste of meat. You can get all the vegetables you need and the Vitamix can do most of the cooking for you when it blends on the highest setting.
Gluten-free diets have the same benefits as vegetarian or vegan diets. You don't need to buy expensive 'gluten-free bread' or 'gluten-free pasta' (or 'gluten-free cookies' or 'gluten-free donuts,' for that matter) to mimic the wheat grains you're missing with this diet because you can easily get your whole grains from healthy sources like brown rice, cornmeal, quinoa, buckwheat, or amaranth. You can also get the starches--you would otherwise get from foods containing gluten--from plant foods like sweet potatoes, almond flour, chickpeas, and tapioca. You should be aware that these substitute foods are normally higher in protein and lower in fiber than foods with gluten so plan your diet accordingly.
Finally, you may want to opt for a BRAT, BRATTY, or CRAM diet for a brief period of time if you have stomach upset issues. BRAT stands for bananas, rice, applesauce, and toast. It is a bland diet for people with gut issues and can be blended easily, but remember that this diet doesn't give you all the nutrients you need daily, so you should only try this diet for a short period of time, in coordination with your doctor. In an effort to increase the nutritional value of the BRAT diet, some people have pushed for adding tea and yogurt (BRATTY). Others advocate switching to cereal, rice, applesauce, and milk (CRAM) because it has more fats and proteins. Regardless of which of these you use, they are only for short-term stomach issues and we only include the BRAT diet in this section because you are bound to find references to it in online tubefeeding forums.