Homemade tube nutrition
Consuming commercial formulas is perfectly acceptable for short-term use of a feeding tube. However, if you will be using a tube long-term, it is a good idea to talk to your doctor or nutritionist about blending your meals--then purchase a high-end blender, like a Vitamix! Blended, or Blenderized, Diets (BD) are basically just homemade meals that have been 'liquified' into a fine puree so that they can fit into your feeding tube. Until recently (the past thirty years or so), blended diets were the only way to get food via the tube. The widespread availability of commercial formulas has caused both an increased use of feeding tubes and a broad acceptance of these formulas as the standard for tube feedings. As you'll see, however, these commercial products have drawbacks and blending a nutritious diet of real food is the best solution for your long-term health.
Pros to BD
There are many benefits to blending real food. One of the biggest is that it allows you to limit your sugar intake. Cancer feeds on sugar, so reducing added sugar in our diet is especially important for oral cancer patients and survivors. Formula companies try hard to pack their product with calories and the right vitamins and minerals for a well-balanced diet. Unfortunately, the most convenient way to pack calories into an 8 ounce container of formula is with added sugar. For example, one bottle of milk chocolate Ensure Plus has 22 grams of sugar. Seven bottles a day (2,450 calories) gives you 154 grams of sugar every day. That's around 40 teaspoons--almost a full cup--of sugar every day. According to the American Heart Association (AHA), you should have no more than 37.5 grams, or 9 teaspoons, of added sugar each day. Naturally occurring sugars, such as those in most fruits, are not a concern to the AHA. Yet too much added sugar can cause a whole host of health problems such as obesity, type II diabetes, cardiovascular disease, tooth decay, and non-alcoholic fatty liver disease. These problems are on top of your immediate concern about sugar's effect on oral cancer.
No matter how hard formula companies work to load their products with an 'ideal' mix of vitamins and minerals, canned formula cannot compare to real, blended food. Vital new compounds or phytonutrients with health giving properties are discovered in natural food on an almost weekly basis. Commercial formula companies cannot keep up with our evolving knowledge of healthy food to copy the nutrients contained in a varied diet. By blending meals, tubies can consume a complete, balanced diet with the proper macro- and micro-nutrients, even the ones we aren't aware of.
Another benefit to BD is that you can tailor your meals to meet your needs. Back in the Commercial Formulas for the Feeding Tube section, we highlighted different formulas to use in case of allergies. We also stated that, "unfortunately, some of the most common food allergens (such as soy, milk, wheat, and corn) are major ingredients in a large percentage of commercial formula." This is especially true for corn. It is extremely hard to find a commercial formula that does not have corn in it. The only one we were able to find, Vivonex TEN, contains corn but is manufactured to be hypoallergenic. On the other hand, with a good blender (like a Vitamix) you can make a wide variety of meals with no corn. The same is true for any allergies (lactose, gluten, dairy, tree nut, legume, etc.) or special diets (vegetarian, vegan, ketogenic, paleo, BRAT, etc.). You can fine-tune your diet to meet your caloric and nutritional requirements on a day-to-day, or meal-to-meal basis. This flexibility allows you to vary your diet (just as oral eaters do) and deal with issues as they crop up, like blending chicken noodle soup and more clear fluids for a head cold.
Believe it or not, a fourth benefit to using BD is that you can't taste your food. This is a great way to look at the silver lining of having a feeding tube. It's true that you won't be able to taste that glazed donut, extra large soda, or juicy bacon cheeseburger you were accustomed to having. But if you're honest with yourself, that stuff was never good for your body and may even have contributed to your cancer in the first place. Now, you can blend all the healthy foods you want without having to worry about how they taste separately or together. Did you always have an aversion to okra, brussels sprouts, or lima beans? Now you can add these extremely healthy ingredients to your blend without needing to worry about your taste buds. The writer of this section frequently blends a sweet potato, can of sardines soaked in olive oil, and an apple with 8 ounces of water. The concoction likely tastes worse than it smells but it is packed with nutrition and has no taste in his PEG tube. Despite what you might think, a feeding tube can help you fall in love with real food and healthy, home-cooked meals.
Still another bonus to BD is that it's easier than you'd think. It often takes less time to blend your food than it would take to make a meal if you were eating by mouth. Many times, high-end blenders like Vitamixers can do your cooking for you. As we discuss above, you don't need to stress about how your ingredients will taste together so meal planning isn't as difficult. You could also blend several meals at once on a Sunday so you don't need to worry about what to make during the week.
Bolus feeding a blended meal feels remarkably different from consuming commercial formula. Formula is often compared to 'eating a brick' by many tubies. BD makes you feel 'full' and you will be able to tolerate much higher volumes of food than if you were consuming formula via gravity. BD 'feels' much different to your body. You may be able to tolerate much higher volumes because your body senses the 'appropriateness' of the food you're eating. An important benefit that can't be overlooked is that blending real food brings more of a sense of 'normality' and de-medicalization to your health care. You have doubtless been through a difficult medical road to reach the point where you need to eat through a feeding tube. Whether you're going through cancer treatment now, in between treatments, or a cancer survivor, just caring for and dealing with a feeding tube feels very medicalized and takes away one more aspect of control you have over your care. Being able to blend your own fresh, real ingredients at home goes a long way toward reestablishing that control and gives you the sense that in your own way you are fighting against your cancer and putting yourself on the right path toward recovery.
Finally, blending your food can improve the diet of your whole family. Once you start putting meals in a blender, you start appreciating food, not just for how it tastes, but how its nutrients will strengthen your health. Before getting a feeding tube, you may have had cravings for fried foods or fast food, or regarded a donut as a sufficient breakfast. When you are forced to calculate calories and nutrients, you become aware of the volume of refined sugars and unhealthy fats in the foods you used to consume. You learn about the best foods to provide the right vitamins and nutrients and how much more appealing these foods are when blended. You gain an appreciation for wholesome nutrition and this awareness will shape the way the rest of your family eats.
Cons/Controversy Surrounding BD
There are drawbacks to blending your own meals. Most of these are just perception, though some are real concerns. We stated above that canned formula could never measure up to real blended food, but this comes with a caveat: the blended food needs to be a nutritious, well-balanced diet. It's tempting, especially if you're looking to gain weight or if you want to revert back to your old diet, to want to blend up unhealthy meals with pizza, milkshakes, cookies, and donuts. Please remember that not all calories are 'good' calories. You need a basic understanding of your nutritional needs to attempt a blended diet. As we've stressed many times, consult your doctor and/or nutritionist before you blend. If you don't have access to the information you need to make well-balanced, healthy meals then you are better off sticking with commercial formula or commercial blended meals such as Real Food Blends.
Another objection constantly raised about BD is that it carries a greater risk of infection. This claim does not have much basis in reality, however. You have about as much chance of giving yourself an infection from a blended diet as you have giving the rest of your family food poisoning when you cook them a meal. As long as you follow normal hygiene and food safety guidelines you should be fine. Use common sense here. Don't leave food out too long. Be sure you store it in the refrigerator or freezer. Thoroughly wash your dishes, including extension sets, syringes, your blender, and the pots and pans used for cooking. Even though commercial formula is sterile when opened, the amount of calories and simple carbohydrates (sugar) in a can actually make it a better environment for bacteria than most blended meals. Important note: if you're using a feeding pump for your meals, you need to take extra precautions with the temperature of your meal whether you are pumping BD or commercial formula.
A third issue raised about blended diets is that they clog the tube. This is true. BD can clog your tube but medications have just as much, if not more, of a chance of blocking the tube--see our section on clogs. You can avoid having your meal clog up the feeding tube if you have a high-end blender like a Vitamix and you thoroughly blend your meals--see our section on Vitamixers and blending your food. Clogs are often brought up as though they constitute a serious medical emergency, but they are no big deal. It is extremely rare that you would need to go to the hospital to break through a clog. Just blend properly and if you are blending foods like berries (the tiny seeds may escape the blades of the Vitamix) or gristly meats, you may want to consider straining your food to make sure there are no potential problems. Even if you are using a normal, or handheld, blender most foods will mix up nice and smooth. This just requires a little bit of prior planning (choose soft foods, rather than steaks or nuts and seeds if you don't have a Vitamix) and perhaps an extra dish to clean (strainer to remove any clumps).
Another problem people have with BD is their perception that it's too much work. Our answer to this is that choosing nutritious foods for your diet and blending your meals takes as much effort as 'normal' people expend cooking at home. You may have no care giver capable of making meals and have physical impairments that prevent you from being able to cook for yourself. If this is the case, then you probably want to stick with formula. If you're willing to try BD, there will be an initial period of a few weeks where you develop a routine of procuring nutritious foods, counting calories, and the mechanics of blending and feeding yourself. After you've gotten used to blending meals, the process will become familiar, quick and easy. You can also develop storage systems and make your meals in advance so you don't need to worry about it during the week or on long trips. You'll find that the work is rewarding because it brings you a connection with your food and the sense that you are taking control of your own care.
Cost is a fifth concern that may be raised about BD. For some people, it will be cheaper to buy real food and blend it than to pay for enough formula to thrive every day. A six-pack of Ensure Plus will be about $10 at most American grocery and drug stores, so this means it would cost around $350 to buy enough Ensure Plus to eat for a month (if you consume 7 cans a day). For specialty formulas this could be much more expensive while generic formulas may be cheaper. Regardless, over the long term, it would be more cost-effective to buy normal food and blend it up for your meals. On the other hand, your formula may be partially, or fully, covered under your insurance plan or government health care policy. For this reason, you may be loath to abandon 'free food' and go back to paying for your meals--not to mention the high cost of a quality Vitamixer. This all comes down to your personal decision. If you're already buying groceries for the rest of your family, it wouldn't be much extra to add on what you'll need for your meals. Also, you may find that less food goes to waste because it is not as hard to consume leftovers when you only need to throw them in the Vitamix. With enough prior planning and smart shopping, BD can be very cost effective and you couldn't put a price on the potential benefits to your health.
Finally, it is often pointed out that there is a lack of science for, or against, BD. This is true. There aren't really any published studies demonstrating that blended food is superior to commercial formula. Though there aren't many published studies on the long-term effects of formula on human health either. However, there are countless scientific findings on the various effects of diet on our health. New studies come out daily looking at food and nutrition. The way the food gets to the stomach makes no difference: real fruits, vegetables, healthy fats, whole grains and lean proteins will always trump processed foods with added sugar. Again, please talk to your doctor or nutritionist to make sure you're filling your dietary needs.