I’ve already had plenty to say about Abbott Nutrition’s Pediasure Harvest here. If you’ve followed my blog for long, you won’t be surprised that I have more to say.
I know my blog posts have been lengthy recently. I usually strive to keep my blog posts nice and short. However, there is so much information that is extremely important for every family with a tube-fed family member to know due to the recent launch of two products from Abbott Nutrition and Nestle Health Science. These posts are not intended to be read in one sitting, but more like a book read in portions. For all of my posts on these products, visit here and here.
I’d like to show you a portion of the webinar Abbott put together for healthcare professionals about Pediasure Harvest and offer my commentary.
Here, they show a brief history of tube feeding. They are quite incorrect about what exactly happened during the 1960s and 1970s. I give a much more detailed history, based on what can be seen in the medical literature, in my book, Stand for Food. There were not significant concerns about bacterial contamination of pureed food back then. All tube-fed patients were fed pureed food up to that point. They were not showing higher rates of food poisoning or related illnesses than orally-fed people.
In fact, initially, doctors were vehemently against the use of these formulas. You can find multiple articles in medical journals from 1950-1980 written by doctors describing how much more poorly their patients were doing on these enteral formulas compared to when they were fed food. They found patients that were formula-fed had much more severe GI complications and did not recover from surgery or illness as well.
The idea of contamination is specifically mentioned in these articles, in fact, and it is said that they were not observing any problems in that regard. Blended food was placed on ice, and this was very effective according to the medical literature. Doctors who had seen day in and day out how tube-fed patients did while being fed pureed food did not like these formulas for years after their introduction because they observed the decline in their patients’ health when they were fed formula.
You won’t find any articles written by doctors praising enteral formulas and the supposed benefits Abbott and Nestle Health Science claim they brought. The only articles you’ll find with those such claims were written by the companies that produced the formulas.
In time, the companies making these formulas marketed to hospital heads…people that don’t have much, if any, direct interaction with patients. They emphasized cost savings. It was less expensive to have a nurse pop open a can of formula than it was to pay kitchen staff to puree food. That is ultimately why things changed.
Abbott Nutrition and Nestle Health Science will have you believe that physicians saw these formulas as some sort of heaven-sent miracle. Nothing could be further from the well documented truth. Again, I give much more details about this history with citations in my book, Stand for Food, which you can read about here. Today, this history has been lost from much of the medical profession.
What really happened is that patients were fed formulas that were making them sick because it was cheaper to do so. Patient health became secondary to profits. And Abbott Nutrition and Nestle Health Science saw this as an opportunity to make millions upon millions of dollars, the patient’s health be damned.
And now, in their own way, Abbott Nutrition has admitted as much.
I want you to look closely at the comment in blue about these benefits they list of blenderized diets (BTF = Blenderized Tube Feeding)…you know…under the sentence with the big typo…since that is how much effort they put into this webinar. “Overwhelming evidence that diet high in fruits, vegetables and healthy fats and low in sugar and processed food decreases chronic disease.” Yes, there are some more grammatical errors there. But, I digress.
Let me tell you what Abbott is saying here. “The formulas we have been making and pushing onto doctors and dietitians…and therefore, parents and patients…have been making tube-fed children and adults sick for decades.”
Next: “Improved feeding tolerance” and “less constipation and reflux.” In other words, again, “The formulas we have been making and pushing onto doctors and dietitians…and therefore, parents and patients…have been making tube-fed children and adults sick for decades. Our products have been causing people to suffer from reflux and vomiting unnecessarily for many years. We have ignored that fact all this time.”
Next: “Faster progression to oral feeds.” In other words, “The formulas we have been saying are so wonderful for children with oral aversion have actually been slowing their progress toward oral eating.”
And Abbott, please stop saying the word “feeds.” Our children are not a herd of cattle. We feed them meals, breakfast, lunch, snack, dinner, and so forth. I really doubt when you sit your child down at the table for a meal, you say that you’re giving your child a “feed.” While we are on the subject, I also doubt you’re giving your child a can of Pediasure Harvest for their meals every day, either. Or any of the formulas you’ve worked so hard to push onto us.
Why the movement back to blenderized diets? Because the formulas made by this company and others have been making tube-fed people sick for far too long, and the tube feeding community has had enough.
Here are some more:
More and more studies showing how much patients improve when they are fed real food just like they had been for millenia until greed got in the way. What Abbott doesn’t mention is that as they’ve been seeing dollar signs this whole time, countless numbers of children and adults who have already had more than their fair share of obstacles as it is have been made sick by their products.
None of this research Abbott is presenting is new or groundbreaking. As you can read in my book, Stand for Food, which can you learn about here, studies have shown from early on, as far back as the 1970s, that patients do not do nearly as well on these formulas as they do on pureed food. Volume tolerance is worse with enteral formula, including elemental formula. More reflux, diarrhea, and constipation are seen with enteral formula. Patients that had handled bolus feedings of pureed food just fine suddenly required continuous feeding with a feeding pump when they were tried on enteral formula.
Abbott mentions that there is overwhelming evidence that diets high in various real foods are associated with better health outcomes as if this is an idea that was just discovered a year ago. We have known this for decades. Abbott has known this for decades. Nestle Health Science has known this for decades. But, they did nothing. They changed nothing.
They continued cranking out their formulas and getting rich from making people sick. I don’t understand what kind of a person could knowingly make young children sick and then laugh all the way to the bank with their bags of money. While you expect the industry to change as science discovers more, this change did not happen because of a new scientific discovery. We have had access to this scientific data for over 40 years.
“Often differentiated in the research literature.” As they should be. Diets of real food with all of their natural vitamins and fiber, enzymes, cofactors, and more are not comparable to the concoctions of sugar, oil, protein powder and synthetic vitamins these companies make.
I want to emphasize here that synthetic vitamins are not the same as those naturally found in food. Vitamins naturally found in food are absorbed better and provide benefits the synthetic version of those same vitamins do not. We know this to be true, and we have known this for quite a long time. When these formulas are called things like “nutritious,” that is really an incorrect statement. Sugar, oil, protein powder, and synthetic vitamins are not nutritious, especially in the context of products like these being fed for a person’s entire diet.
Enteral formula and blenderized diets are completely different and not comparable on any level. They absolutely should be differentiated because they are very, very different.
On that note, let’s play a game. Did you grow up watching Sesame Street? Remember this game?
One of these things is not like the others. Which one doesn’t belong?
The medical literature differentiates between enteral formula and blenderized diets. Absolutely correct. We do, too.
The third bullet point from the bottom makes a pretty strong statement, though I don’t think Abbott Nutrition realized this at the time. Of those feeding food rather than formula, only 25% worked with a registered dietitian. This means 75% of families using pureed food for tube feeding have chosen to not see a dietitian.
I can explain why. At first, parents, caregivers, and tube-fed patients were told the reason so many tube-fed people were vomiting and having terrible digestion problems was because that is simply how it is when a person is tube-fed. It is a consequence of the feeding tube.
In time, people started to figure out it really wasn’t the tube. It was what was being fed through that tube. These enteral formulas were making people sick. So, they stopped using the enteral formulas and began feeding blenderized diets of real food. More and more people were learning about what these enteral formulas really are made of and their impact on health. As a result, more and more people were choosing blenderized diets.
Abbott Nutrition and Nestle Health Science saw this threat to their profits. Every meal that a caregiver or tube-fed patient blends up in a blender at home results in a profit loss for the makers of enteral formula. Profit margins are extremely high on enteral formula. Their ingredients are dirt cheap, but the products are sold at a substantially inflated price. They weren’t about to sit back and watch their sales go down the toilet.
So, Abbott Nutrition and Nestle Health Science both began conducting very flawed research with extremely poor study design. Abbott went to Iran, for example, to hospitals already well documented to have kitchen food that is heavily contaminated. They tested the pureed food from those kitchens and then, spread the claim to the medical profession that, supposedly, blenderized diets have been shown to have high levels of bacterial contamination, never mentioning the context in which these studies were conducted.
Both Abbott and Nestle Health Science spread baseless and unfounded fears that people on blenderized diets would be at a very high risk of getting food poisoning. They said enteral formula was “complete nutrition,” and people being fed blenderized diets could become dangerously malnourished. After all, food has variable levels of nutrients (notice this did not stop those working at Abbott and Nestle from eating food themselves with all of this nutrient variability that they claimed was so dangerous).
Their idea was to make blenderized diets look dangerous…a liability. They wanted doctors and dietitians to be frightened of blenderized diets. Then, the medical profession wouldn’t recommend blenderized diets to patients, enteral formula would be used instead, and the money would keep rolling in. That was their plan.
Their success was only partial. They were actually quite successful at instilling fear into much of the medical profession. To this day, most of the medical profession remains grossly misinformed about blenderized diets and enteral formula. My son’s dietitian told me, “Ohhhhhh…what you’re doing is just so, so dangerous….ohhhhhh…I just…ohhhhhhhh…I’m so worried.” My experience is not uncommon. So, in that regard, Abbott and Nestle Health Science were very successful.
However, they did not accurately predict the response from the tube-fed community. When doctors refused to approve of blenderized diets and prescribed enteral formula instead, we just stopped using the formula and didn’t listen to the doctors. When dietitians argued against real food, favoring enteral formula, we just stopped seeing them at all.
And who can blame us? When enteral formula caused my son to be debilitatingly ill and miss out on such important developmental windows, something that still affects him to this day, and when it became so clear to me that the enteral formula was truly the cause of the severity of my son’s digestive issues, would any reasonable person expect me to continue to feed him enteral formula?
Well, the dietitian did. She was completely against a blenderized diet in spite of the benefits it had brought my son. She still insisted I feed him enteral formula, a diet that had landed him in the hospital more than once. She was so fearful of blenderized diets that she thought a diet that was making my child so ill that he was being repeatedly hospitalized was the safer option.
She gave these very reasons pushed into her mind by Abbott Nutrition and Nestle Health Science. She told me he could get food poisoning. She told me I had no way of knowing whether it was complete nutrition. After enough arguing on the subject, I just stopped speaking with her, just as any mother do would in my shoes. That is why only 25% of parents feeding real food to their children see a registered dietitian.
This fear mongering is still part of their plan, as you can see here.
“Unsure nutrient intake” and “higher level RD education” for home blends vs “Known nutrient composition” for formulated products. In truth, children have repeatedly shown blood levels relevant to nutrition far better when on home blends than formulated enteral products. Higher level education for the registered dietitian? Did they seriously just say that registered dietitians aren’t educated enough to figure out what food to feed a child? If that is true, that is a really alarming statement about the nutrition programs currently available in our universities.
After the recipes I’ve seen parents come to me with that were given to them by registered dietitians, I can’t entirely disagree with Abbott’s statement here. I have seen recipes filled with foods well known to be difficult to digest and not tolerated by most children with feeding tubes. When the child then doesn’t do well, the dietitian says they do not tolerate a blenderized diet when in reality, the child did not tolerate the ridiculous recipe given to them by the dietitian. I have developed starter blends for countless parents to feed to their children who were vomiting on the dietitian’s recipe. When they changed to my recipe, the vomiting stopped because my recipes are based on the knowledge I’ve gained about foods that help digestion rather than worsen it.
I have seen recipes from dietitians that are completely absent in grains and instead, include table sugar for all of their carbohydrates as well as other glaring problems. Dietitians are not often taught about real food. That much is clear. While I ultimately blame our nutrition programs for these occurrences, it is time for dietitians to stand up and begin demanding more proper education on these matters. Dietitians are attending nutrition programs, not Formula University.
“Lower risk microbial contamination” for formulated products and “higher risk microbial contamination” for home blends. In fact, a survey showed the incidence of food poisoning in children fed home blenderized diets is quite low, substantially lower than the incidence of food poisoning in the general population. Studies have also shown formulas to have pretty shockingly high amounts of bacteria in them when you consider the high heating they’ve been put through.
Hang time for home blends is not 2 hours. It is if you’re just allowing the blended food to sit at room temperature. However, with ice packs properly placed around the feeding pump bag, home blends remain at a safe temperature for 12 hours. Yes, we’ve tested this. We’ve tested this because that is what us moms have had to do since the healthcare industry is not doing these tests. We’re doing our own research and collecting our own data. We are the ones that have brought science back to the tube-fed community, something that should have never been taken from us to begin with.
Abbott Nutrition and Nestle Health Science have worked very, very hard to make blenderized diets terrifying. The medical profession may have fallen for it, but moms know better. We see the difference in our children. And despite Abbott’s claims that we don’t think our children are worth the time and effort of going to the grocery store and cooking them food, which you can read about here, they’re wrong again.
Their plan pretty much blew up in their faces, and sales continued to decline in spite of their best efforts. Now, suddenly, after campaigning against real food for tube-fed people for years, after writing manuals (link here) about food being very dangerous while citing very poorly designed research, after all of that, they’re now going on and on about the benefits of real food that we’ve known about for decades as they market their first real food product (and by the way, the product still totally sucks, but I’ll get to that).
Look at what they say.
First, let’s jump to the third statement in this graphic. Blenderized diets are safe if they’re monitored by experienced registered dietitians. Oh? According to the data presented in this very webinar, it appears 75% of families choosing blenderized diets are doing just fine without this monitoring.
Let’s jump back up to the first statement. Sorry to anyone that doesn’t appreciate my language choice here. But, I have no other way I can express this. Abbott Nutrition, you are a pharmaceutical company that is a part of the medical industry. You are not supposed to be getting your knowledge from “patient demand.” You are supposed to be getting your knowledge from SCIENTIFIC DATA, you dumbasses.
And that data has been available to you for a very, very long time. You have completely ignored it because that data wasn’t part of your financial interests. Food has far reaching implications beyond macronutrient properties, you say? Are you going to pretend like you’re just now figuring that out? This isn’t news. You haven’t cared about this information because patient health was never a part of your equation.
Products like Pediasure Harvest are what happens when patient health is not a part of the equation. There are several reasons I dislike this product, but I’ll touch on only one here in this post. The very first ingredient in Pediasure Harvest is banana. Most of you with children with feeding tubes will understand how ludicrous that statement is. BANANA. If Abbott had taken the time to do the slightest amount of research on this subject, they would have known that the vast majority of tube-fed children do not tolerate banana in any quantity, let alone as the most abundant ingredient in their diet. Even if that was not true, no one should be eating more banana in their diet than any other ingredient. This is not a well balanced diet.
So why did Abbott choose banana as it’s primary ingredient? Clearly, it was not because they wanted to make a product specially designed with the health of tube-fed children in mind. They chose banana because bananas have a lot of calories and because they’re cheap. They saw cheap calories and jumped in with both feet and with their eyes closed, which is exactly what they’ve always done.
They’ve never ran proper clinical trials on their products before deciding whether people should be fed these products. They’ve never done research to find out the truth about any of their products before making claims about them to the medical profession. For example, they’ve told doctors and dietitians for years that elemental formulas are very gentle on the digestion system and easy to digest. They’ve told doctors and dietitians their elemental formulas leave the stomach faster and are perfect for patients with reflux and problems with gastric emptying.
Abbott Nutrition has never done a single study to even see whether that is true. Others have, though. And every time elemental formulas have been studied, they have been shown to worsen reflux, to delay gastric emptying, and to slow motility. They have been shown to completely obliterate the gut microbiome, something absolutely vital to good health, in as little as 21 days. We have known for over 40 years that elemental formulas significantly increase the risk of NEC in premature and low birth weight infants, though you will have a hard time finding a doctor or dietitian that is aware of this connection. Now that we know these formulas completely wipe out their gut microbiome, we have a better understanding of why. When gut bacteria is wiped out, opportunistic infections can, and often do, occur.
This issue hits close to home for me. My son was placed onto elemental formula due to a dairy allergy when he weighed only three pounds. I had doctors and nurses telling me this was such a great formula because everything was broken down. It was so good for his digestion, they said. Back then, I was the mom in shock who had given birth to her less-than-two-pound baby and sat through the additional shock of being told her baby has a congenital heart defect. I should not have had to look up medical journals to verify everything the NICU staff was telling me. It was their job to know these things.
One month after being fed an elemental diet, my son developed NEC. This led to scar tissue accumulating in his large bowel, which caused a total bowel blockage. He then needed two surgeries on his bowels at a time when he was very medically fragile. While doctors and dietitians sing the high praises of these elemental formulas and their impact on the gut, the large surgical scar that runs from my son’s chest all the way to his belly button has a different story to tell about these elemental formulas. The science about them has a different story to tell as well.
My son’s motility was and forever will be impacted by those surgeries. It is very possible that none of that would have ever happened had his dietary decisions been based on the scientific data about these elemental formulas rather than what the pharmaceutical companies told the staff at a steak dinner. One of Bradley’s NICU nurses, after learning all of this information, said to me, “You’re right. We do just listen to what the pharmaceutical reps tell us.”
This is why claims should not be made in the field of medicine without the proper research done to back up those claims. Life altering, irreversible mistakes can be made when that happens. In science, which is what the field of medicine is supposed to be based on, a person cannot just stand up and declare something to be true. They have to provide scientific data that has been properly collected and analyzed to support that claim. Otherwise, they are just making stuff up. This isn’t a field that can afford to just make stuff up.
These companies have been making kids terribly ill with these formulas, and doctors are scratching their heads saying, “I don’t know why they’re vomiting these formulas. They’re gentle and easy to digest.” No study anywhere has ever shown these formulas, elemental or not, to be gentle and easy to digest.
Tube-fed patients were being fed pureed food and thriving on it. Then, everything changed to enteral formula without any research first to even see if that was a good idea. To this day, no study exists observing the long-term use of enteral formula. It has never been studied a single time. Yet, claims continue to be made that these formulas are safe and effective as a sole source of nutrition for years and years.
Now, even short-term studies have shown that tube-fed patients should have never had real food taken away from them. Multitudes have suffered greatly and needlessly because of this mistake.
Now, after causing so much harm to the tube-fed community, Abbott Nutrition has the audacity to come onto the scene and claim they’ve come up with a “novel” new formula? Yeah, they’re actually calling it that when they talk to the medical profession. There is nothing novel about feeding food to tube-fed people. People have been home blending for an extremely long time. Companies already exist that make prepackaged real food products for tube feeding.
Developing a formula that isn’t properly researched, isn’t focused on the health of the patient, and that is focused on profits only is also not novel, sad though that reality may be.
Just like the fear mongering Abbott Nutrition has done for years, it appears many dietitians are eating all of this up as well without doing their own adequate research. Just this weekend, I received an email from a parent asking about Pediasure Harvest. She explained she had told the dietitian she would like to try Nourish, made by Functional Formularies, with her child.
The dietitian refused to approve of Nourish telling the mother that Nourish had too much protein. Instead, she wanted the child fed Pediasure Harvest. It took me 2 minutes to look up the protein content of each of these products and calculate their protein content. I want to emphasize that again. It took me two minutes.
Nourish has 14 grams of protein in 400 calories. Pediasure Harvest has just over 15 grams of protein in 400 calories. The dietitian told the mother that Nourish has too much protein for her daughter and then suggested a formula that has even more protein instead. I don’t need to explain how illogical that is.
Dietitians, I know there are good ones of you out there, but far too many of you are paying virtually no attention to any details about the products you’re recommending and not recommending. I don’t know how many times I’ve heard a parent tell a story in which they asked very basic questions about the ingredients or sugar content of a formula their child’s dietitian was recommending to them, and the dietitian sat there with a blank face because they did not know the answer to such simple questions about the very products they were recommending.
This is beyond unethical. And I know why it’s happening. It’s happening because Abbott Nutrition and Nestle Health Science keep taking these people out to lavish steak dinners. They faun over their unresearched products as they wine and dine the doctors and dietitians. Nearly everyone has a great time, believes every word said to them without doing any double checking, and out the door they go, ready to be sales people for Abbott Nutrition or Nestle Health Science rather than being doctors and dietitians whose practices and recommendations are based on facts and data. This needs to stop.
And it is going to stop. Can you guess what that mother did whose dietitian was pushing Pediasure Harvest while giving completely wrong information about its protein content and the protein content of Nourish? She stopped seeing the dietitian. The more that dietary advice is based on steak dinners rather than science, the less parents, patients, and caregivers there will be that are willing to bother with hearing that dietary advice, let alone following it.
There really is only one thing Abbott Nutrition and Nestle Health Science could do at this point to win any favor with me and the many parents of tube-fed children I’ve come to know. And this would be nothing less than what the tube-fed community fully deserves from them. What they really owe us is a public apology.
They owe us an apology for ignoring patient health for so long. They owe us an apology for their recklessness. They owe us an apology for every infection that was not fought off well, every seizure, every vomit, every reflux episode, every stomach ache, every killed gut bacterium, every C. diff infection, every NEC infection, every case of SIFO, every case of SIBO, every type 2 diabetes diagnosis, every high blood pressure diagnosis, every cardiovascular problem, every kidney problem, every developmental delay, every blood test result showing a nutrient deficit, every experience of constipation, and every experience of diarrhea that has been directly caused by the use of their enteral formulas over the years.
Just like Nestle Health Science’s Compleat Organic Blends, what Abbott has done here is far too little, far too late. Just say no.
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