Blenderized Tube Feeding: What Does the Research Actually Say?

I often hear, “I’m ready to try blenderized tube feeding (BTF), but my medical team tells me it’s not safe.”

Understandably, this leaves many families feeling confused and frustrated, as many of the concerns expressed don’t always make sense. My guess is if you’re reading this, you may be feeling this way too.

I find the issue often lies in medical professionals relying on outdated information. But good news – there’s growing research supporting BTF, and the American Society of Enteral and Parenteral Nutrition’s (ASPEN) latest practice recommendations from fall 2023 are helping clinicians get on board.

In this blog post, I’ll tackle common worries about BTF and show, with research-backed info, why they’re manageable and don’t actually have to be concerns with the right approach.

Common Concern #1: There is No Benefit of BLENDED Food Over Formula for Tube Feeding

I continue to be surprised by how many families hear this from their medical team, especially given how much research is out there backing up the benefits of BTF.

And this body of literature only continues to grow, many of them finding people have less nausea and vomiting, less abdominal pain, less diarrhea, less worry about stool, and fewer episodes of reflux and aspiration when receiving real food compared to synthetic formula3.

And while experts have not pinned down exactly what leads to these improvements, there are a few well accepted thoughts. First, real food is thicker, which can help with things like reflux and vomiting4. It may also be that real food offers more nutrient diversity, and supports a more natural rhythm in the stomach’s movements4.

I couldn’t agree with these theories more! I see this over and over with families inside Blended Tube Feeding Made Simple.

Studies are also showing children continue to follow similar growth curves after switching to a blended diet, even observing an improved trend in weight z-scores and statistically significant improvement in height z-scores2.

And these are just the physical benefits. Many studies show people on blenderized diets (or their caregivers) report greater satisfaction ratings compared with those receiving conventional formula3.

One of the most common reasons that families want to use real food is to normalize the tube feeding experience. A blenderized diet allows people fed by feeding tube to be included in family meals, share in the preparation of food, and nurture themselves or their loved one in a unique way5. Read about how real food made the holiday season much more inclusive for a family here.

I could go on and on about the benefits, but no one wants to read a 30 page blog post :). So if you’re curious to learn more, check out the references included at the end.

Common Concern #2: Increased Risk of a Foodborne Illness on a Blended Diet

Many clinicians feel a blended diet is more risky than commercial formula because preparing and storing real food could increase the risk for bad bacteria growth.

You might be surprised to learn that current literature does NOT actually support these worries. No connection has been found between getting sick and using blended food for tube feeding 1 !

I also think it’s worth noting that these studies are comparing the risk to using formula, not to eating by mouth. Because let’s think about it — isn’t the risk of foodborne illness something everyone faces if they consume real food?

Yet, people who eat by mouth aren’t told to stop eating because of it. It’s important we think of a feeding tube as simply another path for nutrition to enter the body.

It’s not inherently riskier from a food safety standpoint just because the food is delivered through a tube instead of by mouth. What matters is the care in preparation and handling, just like with any meal!

You just need to keep those surfaces clean, cook and store your food correctly, and keep things at a safe temperature…that’s it!


Still concerned or getting push back? Here are a few things to think about to ensure you’re extra safe:​

  1. Follow typical safe food handling practices when preparing blended food: Keep things clean, keep raw food separate, cook food to a safe internal temperature.
  2. Blend food the way you would eat it! Do not blend spoiled foods or non-edible items even if they are nutrient dense, and cook foods that should be cooked.
  3. Keep food at a safe temperature. Real food should not be out of the refrigerator longer than two hours, or one hour at temperatures above 90°F.  This goes for when you’re preparing or feeding the food!
  4. Discard unused refrigerated prepared BTF after 3-4 days, which is consistent with USDA leftover guidelines.1

Common Concern #3: A Real Food Blended Diet Will Clog a Feeding Tube

With the right equipment, it’s easy to avoid clogging a feeding tube! And in fact, evidence is lacking comparing tube clogging between BTF and commercial formulas1.

I understand the concern, most people’s feeding tubes and current tube feeding supplies have pretty small openings, likely made with formula in mind.

But what many medical professionals are not aware of is that there are powerful blenders out there that can completely liquify food, minimizing the risk for clogged tubes. It’s pretty amazing what these blenders can do!

How Can You Prevent Clogging a Feeding Tube on a Blended Diet?

  1. Invest in a high-powered blender like Vitamix or Blendtec if you’ll be doing this for a while, it is 100% worth the money. Medical discounts make them more affordable.
  2. Take into consideration your current feeding tube size. A feeding tube size of 14 French or larger is recommended, but smaller feeding tubes can be used with thinner blends and diligent flushing it techniques1.
  3. Always flush the feeding tube with water after giving blended food.
  4. Blend your food for at least 3 to 6 minutes, especially when using foods with tough pieces, seeds or peels.
  5. Use a fine mesh strainer to sieve your meals if needed! This may not be appropriate if you are using a standard blender as there may be quite a bit of nutrient loss.

Common Concern #4: It is Too Difficult to Meet Nutrient Needs on a Blended Diet

If you’ve gotten this far, you can probably guess that this concern is not well supported in the literature either. Studies have found blenderized feeds provide increased diet diversity as well as an improved nutrient profile for patients compared to conventional formulas3.

Some studies are even finding BTF increases the diversity of the microbiome in pediatric patients that were switched from enteral formulas to blended diet2!

Yet many are told it’s “too hard” to meet nutrient needs on a blended diet so they shouldn’t do it. This can be a bit confusing and disheartening! Especially when many children live off french fries and chicken nuggets, and many adults have limited diet, and no one seems to care.

Its hard for doctors and dietitians to think differently about tube feeding from how they were taught. They learned to pay close attention to how much of each nutrient a person gets every day from formula, because with formula feeding, the exact same thing is provided daily.

If that plan is low or missing in nutrients, that person WILL develop a deficiency over time, so it needs to be “nutritionally complete”. But this does not translate to real food, which offers the advantage of flexibility from day to day and nutrient needs can be met overtime.

Most people do not eat a perfectly balanced diet every day, but are still able to meet nutrient needs, right? So when we hold blended diets to this unrealistic standard of daily perfection we are causing many people fed by feeding tube to miss out on the benefits of real food.

And this may be controversial, but I’d even argue that a mediocre blended diet for tube feeding is often more nutritious than most oral diets, especially when compared to the typical American diet.

It’s a challenge to let go of that pressure to have every meal be textbook-perfect, I know it was for me. But if we are honest, we all have room for improvement in optimizing our nutrient intake!

And of course, it’s still important we do our best. So how can you be sure you’re meeting nutrient needs? Well, really it’s the same way you do for someone eating by mouth:

  • Include a variety of foods from all food groups if able (or supplement if needed)
  • Work with dietitian to assess intake periodically and look for a nutrient gaps
  • Monitor weight and growth
  • Get lab work if indicated

The Future of Blenderized Tube Feeding

As Katherine Bennett, RD, MPH, CLE, and colleagues said so beautifully, “ASPEN’s founding purpose is to ‘provide optimal nutrition to all people under all conditions at all times.’ Healthcare providers, especially registered dietitians, need to educate themselves on BTF and its benefits, and consider the use of BTF with any enterally fed patient as part of their assessment to include all options in the development of an optimal nutrition care plan.5

This shift towards consuming a natural, whole foods diet continues to grow, and it’s important we as healthcare providers become comfortable and knowledgeable with BTF so we can better serve our patients and empower families to make informed choices to positively affect their long-term health.

So if you are a dietitian or other healthcare professional reading this, I encourage you to update yourself on the latest literature and review the ASPEN practice guidelines (see references below).

And if you are a parent or caregiver, or person fed by feeding tube, I hope this provides you with some reassurance BTF is not only safe, but also provides SO many health benefits.

This blog post only scratches the surface of the literature available, but I hope it arms you with knowledge to confidently talk to your team about this so you can feel well supported from all angles.

And if you’re curious to learn more about this alternative approach to tube feeding and the benefits of real food, check out this post next.

Hilarie, RD, CSP

*Disclaimer: The information and education provided here is not intended or implied to supplement or replace professional medical advice. Always check with your own medical professional before trying to implement any information provided here

References:

  1. Blenderized tube feedings: Practice recommendations from the American Society for Parenteral and Enteral Nutrition https://pubmed.ncbi.nlm.nih.gov/37787762/
  2. Efficacy and Tolerance of Blended Diets in Children Receiving Gastrostomy Feeds  https://pubmed.ncbi.nlm.nih.gov/31549432/
  3. Health Outcomes and Quality of Life Indices of Children Receiving Blenderized Feeds via Enteral Tube https://pubmed.ncbi.nlm.nih.gov/31128885/
  4. Blenderized food tube feeding in very young pediatric patients with special healthcare needs https://pubmed.ncbi.nlm.nih.gov/36871186/
  5. Blenderized Tube Feeding: Health Outcomes and Review of Homemade and Commercially Prepared Products https://pubmed.ncbi.nlm.nih.gov/32362020/

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