The power of food: Exploring food-based tube feeding formulas

In celebration of Feeding Tube Awareness Week, Dietitians On Demand is exploring the world of food-based, blenderized tube feeding formulas. This is Part 1 in a two-part series. Click here for Part 2, an inspiring patient success story about Forrest Allen, who survived a traumatic brain injury when he was 18-years old.

Blenderized tube feeding formulas

Food-based tube feeding formulas have been increasing in popularity in the past several years, just as there have been movements toward eating more natural foods with recognizable ingredients. Blenderized formulas can either be prepared by hand with ingredients purchased from the grocery store or selected from a number of commercially-produced options.

The dietitian’s role

As the expert in nutrition, you may be asked to develop a food-based tube feeding regimen. Using blenderized formulas can be done, even in a hospital or institutional setting. Here’s what you need to know:

Select the right patient. Using a blenderized formula, particularly if it is homemade, requires more time and attention to make sure food safety practices are adhered to and all nutritional needs are met. Some patients or families may not be committed to this responsibility, so educate them on what is required to ensure the patient’s needs are met.

Choose between a premade food-based formula and a homemade blenderized formula. More companies are producing whole-food based tube feeding formulas that are either ready-to-feed or only need to be mixed with water. See below for a few examples:

• Nestlé Compleat
• Nestlé Compleat Pediatric
• Nestlé Compleat Reduced Calorie
• Kate Farms Komplete
• Kate Farms Core Essentials
• Functional Formularies Liquid Hope
• Functional Formularies Nourish
• Real Food Blends

Pump vs. gravity vs. bolus. Some blenderized formulas are too thick to be used with a pump. If the patient does require pump feeding, the formula may need to be strained or diluted with water. Be diligent about flushing the tube to avoid clogs. And be aware that many food-based formulas have shorter hang times. (Tip from Forrest’s family: Place the formula bag inside an insulated lunchbox with ice packs to extend the hang time!)

Consider vitamin and mineral needs. Food-based formulas — both premade and homemade — may be lacking in micronutrients. Consider adding liquid vitamin supplements, as needed, to meet the patient’s needs.

Cost may be a concern. Unfortunately, Medicare and Medicaid reimbursement may not be available for patients to use food-based formulas, unless there is a documented allergy or intolerance to standard commercial formulas. You can do your part with honest and clear documentation, particularly if you feel your patient is not tolerating a polymeric formula.

Resources for more information

Click for a copy of Forrest’s smoothie recipe with supplements and without supplements. These recipes are informative only and are examples of what Forrest used. It’s always important to consult with a physician and dietitian in regards to tube feeding nutrition needs.

For more information on Forrest’s recovery, visit his blog. Special thanks to Austin Allen and Dr. Rae Stone for sharing Forrest’s story so openly and for believing in the power of food.

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Reference: Martin K, Gardner G. Home enteral nutrition: updates, trends, and challenges. Nutrition in Clinical Practice. 2017;32(6):712-721.