Nutritionism and Blenderized Diets

I was watching Michael Pollan’s “In Defense of Food,” and I found myself quite struck by a particular portion of his movie. While he was not in any way speaking of diets for tube-fed people, what he said was so relevant to this topic.

You can see the portion I’m speaking of here (and pardon the sound of Bradley playing with his cars in the background…this is life, lol):

The most common feedback I receive from parents about feeding their tube-fed child a blenderized diet (a diet of pureed food through a feeding tube instead of the more typical tube-fed diet of enteral formula) is their extreme fear of “messing it up.” What if they miss a certain nutrient? What if they can’t figure out the correct amount of fats and carbs? Likewise, they get concerned about how time consuming they are told blenderized diets are because it supposedly requires so much calculating.

I explain in my book, Stand for Food, that these fears are unfounded. Those who have gotten to know me well through the online blenderized diet community know one of my most frequent statements: “It’s just food.” Don’t make it more complicated than it is.

During the 60s, science was seen as much more capable than it actually is. We were going to solve virtually all problems with science, we believed. And don’t get me wrong, I love science. Scientific data is so important as our guide to truth. However, the claim was made back then that through science and technology, we could masterfully piece together a diet far superior to what nature provides. This claim was entirely wrong.

During this time period, enteral formula was invented. Prior to this time, virtually all tube-fed people were fed pureed food. Enteral formula came along with claims that because it had an exact and predictable amount of carbohydrates, fat, synthetic vitamins, etc., it was superior to a diet of food. Outrageous claims were made that people living on these formulas would be so healthy, they would live to be 150 years old. As we have seen, that was entirely incorrect.

Enteral formulas have changed very little since then. The vast majority of carbohydrates come from forms of sugar. They contain only synthetic vitamins. Even the fiber in most enteral formulas is entirely synthetic. They contain absolutely 0 phytonutrients, which are essential for long term optimal health. Whole food contains cofactors and other components that allow our bodies to better absorb the natural vitamins found in the food. Enteral formulas contain none of these components. I am sure there is much more to food than we’ve come to learn and understand at this time, which is all the more reason we cannot create a diet superior to the food nature provides.

In spite of these very significant negative aspects of enteral formula, most doctors and dietitians continue to press enteral formula onto tube-fed patients and their caregivers, explaining it is far better, and they discourage the feeding of food to tube-fed people. Why? How can this possibly be the case?

I believe in Michael Pollan’s explanation of what he calls Nutritionism, we find the answer to this question. The nutrition of tube-fed people has been approached with the idea that a precise calculation of specific nutrients is best and that a tube-fed diet consists of nothing more than a sum of various nutrients, whether synthetic or otherwise. Interestingly, the very people telling many of us that it is so vital to have precise control over nutrient levels do not eat this way themselves. They just eat food. They feed their children food. And never do they sit down to calculate whether they are eating or feeding precisely 55% carbohydrates, etc. With tube-feeding, they have been told by the representatives of companies that make enteral formula that this precise control is extremely important. Yet, no data anywhere supports this claim.

I assure you, such precision is not necessary. I met a mom a while back who was told she had to feed her child enteral formula overnight with a feeding pump because the child had a congenital illness that caused him to be unable to manage his blood sugar level well. Thus, he needed fed throughout the night through a feeding tube as he slept to keep his levels steady. The dietitian told her it was essential this mother use enteral formula to accomplish this because it gave very precise control over carbohydrates. While this mother could count carbohydrates in food, it would not be super precise and therefore, was not recommended. Yet, in spite of this precision found in enteral formula, the child’s graph showing his blood sugar levels throughout the night displayed wildly out of control blood sugar levels with multiple spikes and drops that reached dangerous extremes.

She decided to try feeding a blenderized diets instead. In spite of all of its non-precision, the child’s graph showed a beautiful, stable line with only very small rises and falls in blood sugar level all night long the very first night. Not once did his blood sugar reach a dangerous high or low. He has continued this pattern for months on a diet of real food rather than enteral formula.

This idea of Nutritionism not only has led medical professionals to favor enteral formula, but it has led them to be quite fearful of blenderized diets. The most common question a parent that feeds her child a blenderized diet is asked by medical professionals is, “How do you know your child is getting everything he needs?” Terror that the child will become horribly malnourished in one or more nutrients is sown, and parents hesitate to feed their tube-fed child food instead of enteral formula as a result.

However, these fears are never cast onto parents of orally-fed children. Look at the nutrition advice given to parents of orally-fed children. They are never told to insure their child receives X amount of vitamin A and Y% of calories from fat. Instead, they are shown a plate with the various food groups and their relative recommended proportions. The focus is not on individual nutrients, but overall amounts of various groups of food. In other words, nutrients are never even brought up. The focus is instead on actual food.

Parents, this is how tube feeding can be approached as well. Count calories if you need to. Otherwise, monitor food group ratios to make sure they are reasonable. This is all you need to do. It’s what parents around the country and the world are advised to do every single day with their orally-fed children. Having a feeding tube does not change the way nutrition should be approached. You are not going to mess it up, mama. It’s just food.

Of course, there are those with special dietary needs that do require more precise calculating. For example, children on a ketogenic diet must have their carbs calculated. This frightens many parents away from a blenderized diet. Yet, there are many orally-fed people with these same dietary needs, and they consume food. They do not sit around drinking enteral formula all day. From what I’ve seen anecdotally, by the way, children on a ketogenic blenderized diet do much better than children on a ketogenic enteral formula.

While there are conditions that require more precise calculating in one’s diet, having a feeding tube in general is not one of those conditions and there is no reason a tube-fed person would need more precision in their diet than an orally-fed person.

It can be hard to let go of what I have called “formula thinking” when it’s been so pressed onto us tubie parents that very, very precise calculating is necessary for our children’s diets. I like this phrase of “nutritionism” better. Do not fall into this thinking.

A blenderized diet is not an attempt to make a formula out of food. A blenderized diet is a rejection of the idea that tube-fed people require a formulaic diet in the first place.

A blenderized diet is just food.