How-To Basics

I suppose I should start this off with the generic disclaimer. I am not a doctor. I am not a licensed dietitian. I am not giving orders or prescribing anything. I just know this has changed my son’s life and the lives of many other tubies.

However, I have helped thousands of families transition their children to a blenderized diet successfully, and I have also read over 300 scientific studies relevant to this topic.

Please feel free to ask any questions about starting a blenderized diet. I love helping my fellow tubie mamas!

So, let’s start with the basics.

What is a blenderized diet?

A blenderized diet, known as BD, is a diet that consists of real food that is pureed in a high powered blender and fed through a feeding tube.

Kind of. Some people use lower level blenders and then strain the food through a fine sieve to remove any particles. Some people have children with oral aversion that can drink thick liquids, but cannot eat solid food by mouth, so their children drink their BD in the consistency of a milkshake. So, the exact definition of BD is a little loose.

The end of a g-tube is extremely tiny. To puree food to a consistency that can pass through a g-tube, typically, a Vitamix or a Blendtec is required. I use a Vitamix. But, many use a Blendtec. Neither seems to be better or worse for BD. It comes down to personal preference.

I strongly recommend you find a way to get one of these 2 blenders if you are going to feed BD to your child. Straining is an option, but that means fiber and potentially other nutrients do not make it through and therefore, do not make it into your child’s tummy. It is also much more time consuming to use a lower level blender. If there is absolutely no way you can get one of these blenders, yes, you can blend and strain. It is just not the most optimal way. It is still far superior to enteral formula.

With a BD, you feed your child exactly the same food you would if he/she ate by mouth. But, you puree it, and pass it through a feeding tube instead.

Why a Blenderized Diet?

Tube-fed children are very prone to vomiting and nausea. I was told by various medical professionals that no one knows exactly why. Maybe the fact that tube-fed children tend to also have complex medical histories? Maybe the tube itself, being unnatural, leads to slowed digestion? As far as I know, they don’t know why. They just know that tube-fed children have significantly higher rates of reflux and vomiting. There is probably not one single answer to the question of why.

However, given the large number of children that had very dramatic improvement with a real food diet, and even a couple of early studies showing quite significant reduction in vomiting after changing to a blenderized diet, I have to wonder if it’s not the tube or the medical problems in many cases. Or at least that those 2 issues are not the only contributors. Maybe it’s the Pediasure and other formulas that most tube-fed children are prescribed.

I accepted the challenge to drink nothing but Ensure for one whole day. I calculated my daily caloric need and drank that many containers of Ensure, split into 3 meals. I expected fatigue and just general yucky feelings. It was so extremely worse than that. After my “lunch,” I had to lay down because any quick movements definitely would have caused me to vomit. I didn’t know if I could even complete the challenge. I was just too ill. It is too rich to handle on an otherwise empty stomach. For dinner, I just slowly sipped it so I could keep it down.

What came to mind was an interesting parallel. So many tub- fed children must be very still for a long period after being fed. And many must be fed very slowly over a long period with a feeding pump. Otherwise, they will vomit. I pretty much experienced both of these scenarios even though I consumed it by mouth.

I would like to try a blenderized diet. How do I convince my child’s doctor/nurse/dietitian/whoever to approve a blenderized diet for my tubie?

I have great news. You do not need to convince them. You do not need anyone’s permission to feed your child food.

Let’s say that together. Ready? You do not need anyone’s permission to feed your child food.

Again. You do not need anyone’s permission to feed your child food.

I say this with no disrespect for the medical profession. I so love and admire the medical professionals that have taken care of Bradley. They are my heroes. I cry tears of gratefulness whenever I speak of them. Bradley would not be alive without them. They are awesome!

But, while I discuss in depth and follow their recommendations regarding my son’s medications, testing, monitoring, etc., when it comes to food, that’s up to me. Just like it is with any other mom. My son having food go through a tube rather than his mouth and throat does not mean his nutritional needs are different. In fact, this is one advantage tube feeding offers. How many parents struggle to get their toddlers to eat a well balanced diet? Tubie mamas don’t. Our tubies eat whatever we choose. They can get so many vegetables, whole grains, seeds, nuts and whatever else we want to use to nourish their growing bodies. Why on earth would we give up that advantage to instead feed them a high sugar, low fiber, artificial diet?

If the fact that you need no one’s permission is good enough for you, then, you can skip the rest of this section. However, there is a decent possibility you will be met with great resistance by at least one medical professional involved in your child’s care. And if you choose to pursue a conversation with this person about BD, you will probably be offered one or more arguments. Below, you will find a list of common arguments and answers to these arguments developed not only by me, but by tubie BD mamas around the world.

If you want to offer more scientifically-based arguments, check out my book, Stand for Food, which is all about what science currently tells us about blenderized diets.

1. Formula is easier. I agree that popping a can open is easier than making and pureeing real food. If something being easier is enough to make it preferable, why is this not prescribed for all children everywhere? Why not simply tell all parents how many ounces of formula to have their child drink daily and leave it at that? It not only would be easier for me, it’d be easier for absolutely every parent. In fact, why aren’t we all on canned liquid diets? We could all save so much time by popping open some cans and drinking our meals and moving on. Something being easier does not make it the right choice. Answer #2: Would you feed your child nothing but Pediasure for years simply because it is easier? Why not? If it is not good enough for your orally-fed child, why is it good enough for my tube-fed child?
2. It will clog the tube. If I puree the food and flush the tube correctly, it won’t clog the tube. If I make a mistake and do clog the tube, there are techniques to unclog it. If those techniques fail, I can remove the g-tube and replace it with a new one. Avoiding this very unlikely scenario that would cause no harm to my child even if it did happen hardly seems reason enough to justify feeding my child a high sugar, low fiber diet with artificial ingredients.
3. How will you know if your child is getting everything he/she needs? How will you know if you’re providing a balanced diet? Does any parent know for sure? Do you ask this question to parents of orally-fed children? Why are they trusted to make decisions about what to feed their child while I am not? Why can some parents feed their children Hot Pockets and McDonalds and not be questioned about it, but I must battle to simply feed my child things like fruits, vegetables, and whole grains? If you are concerned about me making a mistake regarding nutrition, then help me develop a plan.
4. Real food is not sterile. Sometimes, there are food recalls. I know parents of other children my child’s age, including children with complex medical histories, that eat by mouth. No one is telling them not to feed their child food because of the risk of foodborne illness. No one is telling them to sterilize their child’s plates, cups, or utensils. Even when I change my child’s g-tube, it does not have to be done under sterile conditions. If a g-tube itself does not need to be sterile, why would the food that passes through it need to be? I will practice the same food safety practices that I use for myself and my family members. To my knowledge, I have never poisoned anyone. Therefore, I feel confident I will not poison my tube-fed child.
5. Formula has all that your child needs. It may have all that my child needs to survive. But, it does not have all that my child needs to experience optimal health. The carbs in enteral formula are mostly from refined sugars. That is not optimal. It does not have enough fiber. It does not have the phytonutrients that can be found in fruits, vegetables, and seeds. These things are absolutely vital for optimal health, and enteral formula does not have them. I want my child to have what is optimal. That can only be found in food.

Lastly, regarding talking to medical professionals, if you do talk with a dietitian that helps you develop a plan, make sure it is a plan based on the kinds of foods you would feed an orally-fed child. There is a recipe circulating in the BD world given by some dietitians that includes cheap oils known to cause inflammation in the body, corn syrup, and multiple tablespoons of sugar. If you would not stir the recipe you’re given together in a bowl and feed it to an orally-fed child or if you would not eat it yourself, find a new dietitian. Carbs are best consumed through whole grains, not refined sugar, corn syrup or other ingredients like these.

Whatever you choose to do, always keep in mind that while there are many dietitians out there that will make you scratch your head when you hear their recommendations, there are dietitians that firmly understand the value of real, whole food. If you feel most comfortable with the guidance of a registered dietitian, choose one that holds that value. Don’t waste your time with those that don’t. I always say, if a dietitian believes a diet in which all carbs are from sugar is an appropriate diet for my son, I don’t really care what he/she thinks my son should be eating.

Getting Started

This is the hardest part. Figuring out where to begin. If your child has never consumed food and there is a history of allergies in your child’s family, you may want to begin by feeding one food at a time. Or, at least one food category at a time. Give the food for 3 or 4 days, watching for a reaction. Then, move onto a new food. Of course, it would take forever to literally do 1 food at a time endlessly. But, trying something like a berry, a root, etc., can be a good way to at least test larger food categories that contain related foods. Plenty of parents don’t do this at all and transition to a blenderized diet overnight. Use your discretion.

Many parents prefer to calculate their child’s blends to monitor for various macro and micro nutrients. There is nothing wrong with this method, and I used this method myself in my earlier days of BD. Calculating gave me a sense of security and confidence. It also helped tremendously in determining appropriate serving sizes for my son’s age. I had never had a child to feed at Bradley’s age. Parents of orally-fed children learn typical serving sizes by observing how much food their child eats. Eventually, they get a pretty good feel of what to put on the plate. Because we tubie mamas don’t have such an advantage, calculating earlier on can be a good method of determining what and how much we should put in a blend.

That said, calculating every blend is cumbersome and over time, should become less and less necessary. I used to calculate every single blend I fed my son. Eventually, I kept track of the nutritional content of various recipes I make, but I did not calculate my son’s individual blends anymore. I kept a close estimation of calories and insure the food groups are represented in appropriate ratios in his diet. Finally, I changed to simply feeding him like I would if he ate by mouth. I don’t even count calories anymore because I’ve reached the point that I just know how much of what to put in a blender.

For example, today,  for breakfast, Bradley had some oatmeal blended with some cranberries, peanut butter, and a touch of maple syrup. For his morning snack, he had a green smoothie made of water, some baby carrots, some grapes, some unsweetened coconut, some walnuts, and some spinach. For lunch, he had some soup and brown rice blended with some veggies. A little later, he had a cup of soy milk. For a snack, he had another smoothie made of water, a clementine, some strawberries, hemp seeds, and a touch of maple syrup. For dinner, he had whole grain spaghetti blended with some veggies.

This greatly simplifies blending. It’s not necessary to blend together 100 random ingredients. We are not trying to recreate formula with food. A blenderized diet is in no way an attempt to recreate formula with food. A blenderized diet is a rejection of enteral formula. It is a statement that for most tube-fed people, enteral formula was never needed to begin with. So, let this burden be lifted from you.

However, as I’ve mentioned, calculating in the beginning can be a tremendous help, so I am certainly not against it. To use this method, first, decide which nutrients, etc. you want to monitor, based on your child’s needs. Then, discover your child’s daily nutritional needs.

The USDA has a tool in which you can enter your child’s information and find the recommended daily intake of various micronutrients and macronutrients as well as calories and water. That is a great starting point to get an idea of what you’re aiming for. While monitoring each individual nutrient is both tedious and unnecessary, be aware of amounts of fruits and vegetables, etc. that your child needs. For example, Bradley, at the time of this writing, is recommended to have 1 cup of fruit and 1 cup of vegetables per day. So, that is how much he gets at a minimum each day spread over his meals, though he does have more vegetables than this as he is fed a diet based on vegetables and whole grains.

You want the foundation of your child’s diet (and your own diet) to consist of vegetables and whole grains. Then, add some fruit and sources of adequate protein, calcium, and fat (such as from coconut and avocado). The Standard American Diet (the acronym of which ironically spells SAD) is largely centered on meat with some grains, mostly refined, and maybe some fruits and vegetables on the side. This is backward. So, start your child off with the right foundation. They’ll thank you for it.

Once you have chosen what to monitor and set your goal ranges, choose a tool to calculate the nutrients and calories of various foods. This will save a lot of time. I used an Excel spreadsheet to save nutritional information of various foods and to build Bradley’s daily meals and blends. It required an initial investment in time, but has saved me a lot of time in the long term, and I still use this method for calculating the nutritional content of various recipes if I feel the need to check. I offer a program, called Crunchy Coaching, in which you will receive a formatted Excel file to use for this purpose, three suggested starter blends custom made for your child, and an additional 30 days of daily support. You can learn more about this program here.

Any time I fed a food to Bradley, I looked up its nutritional content on the USDA website database. You can even get a good estimate of how much water is in a food item, which is very handy for watching fluids if your child has a medical condition that requires careful and accurate monitoring of fluid intake. I then record it on the Excel sheet. Bear in mind, for most people, it is not necessary to obsess over every ounce of liquid in your child’s diet. Watch to be sure diapers are being wet as expected and for general signs of good hydration, such as healthy skin and plenty of saliva in your child’s mouth. However, some children with specific kidney or heart conditions do need to monitor fluids, so this is a great tool available for those situations.

Each row  in my Excel file has a food. Each column lists either calories, protein, water, etc.

This way, the next time I want to use that food, I have it at my finger tips. Of course, the list grew longer and longer as time goes on. I alphabetize the list for this reason. I did not calculate the nutritional information of every single fruit and vegetable fed to Bradley each day. That would be overwhelming. I looked up many fruits and vegetables and totaled the average nutritional content of a cup of fruit and a cup of vegetables, and that is what I use regardless of the fruits or vegetables I am feeding for that day. It is ok to do this with various foods. Formula use has pressed upon us tubie mamas to carefully calculate every single nutrient every single day. No one eats this way. It is not necessary to be absolutely precise.

When I cook a meal (and I highly recommend you use regular cooked food as opposed to just tossing random items into the blender that would taste odd together), I open a new worksheet and title it with the recipe name. I then find the nutritional content of each ingredient in the recipe and record it on the worksheet. Excel has an auto sum feature. When I’ve entered the recipe, I auto sum each column to see the total of each column in the entire recipe.

Then, I divide those numbers by the number of servings. For example, I made some pumpkin pie pancakes the other day. It made 22 pancakes. So, I divided the recipe’s totals by 22 to determine the average nutrition of an individual pancake. I made a spaghetti recipe that had a yield of 9 cups of pasta. So, I divided each total by 9 and titled that row, “Spaghetti 1 cup.” Knowing I would not always be serving Bradley an entire cup of spaghetti, I then divided the 1 cup columns in half and titled that row, “Spaghetti 1/2 cup.”

Then, I copy the rows containing serving sizes and paste them over onto my food list. Yes, that took some effort. However, now, whenever I want to make that food again, I have a handy recipe, and as I prepare Bradley’s daily meals, I have the nutritional content of each serving ready instantly.

Now, back to the food list. Below that list, I have a section for fluids, breakfast, lunch, and dinner. When I was more closely calculating Bradley’s daily blends, I copied and pasted rows from the food list into this section. Each column is programmed to auto sum (see above), so I can see what is happening in the daily total as I add items to this list. When it was complete and balanced, the blend was built and I got to blending.

It is ok if every day’s blends are not perfectly balanced. Some days, there may be a little less carbs while another day, there are a little more carbs, for example. This is a normal way of eating. Keep in mind as you prepare meals and blends, that you are shooting for a daily AVERAGE. If you’re a little short in one area, make up for it on another day. That’s fine!

This is a lot to take in at the beginning. But, it is a very convenient tool to use over time, and you will be a pro before you know it. Again, if you feel some additional help and support would be beneficial to you as you get started, please read about my Crunchy Coaching program here.

You will learn and grow as time goes on. I will be regularly sharing recipes on this blog with serving sizes and nutritional content, as well as information about various issues relevant to tube feeding and blenderized diets, so visit often and give any recipes that sound interesting a try.

My recipes are not just recipes for your tubie. They are recipes for you and your family members as well! It’s amazing how much your own eating will improve when what you eat is also what your tubie eats. In fact, there are lots of adults with feeding tubes as well, and these same principles also apply to them. They apply to everyone!

FAQ

1. Is a blenderized diet for everyone? No. But, it is for almost everyone almost all of the time. I have read hundreds of studies on this subject and have found there are very few conditions that require the use of enteral formula. Most medical professionals will claim either no tube-fed person can be fed a blenderized diet or that only a small portion of the tube-fed population can. This is absolutely not correct and is in total contradiction to the current scientific data we have. According to all of the legitimate studies ever done on this subject, a blenderized diet fed through a g-tube or j-tube is both possible and superior to any enteral formula in existence. A blenderized diet absolutely should be the default diet for tube-fed people.
2. Do I have to have a Vitamix or Blendtec? No, but blending without one is only recommended if you have no means of obtaining a Vitamix or Blendtec. This is the most optimal and convenient way to feed BD to your child. If you do not use a high powered blender, you will need to strain all blended food through a fine sieve to remove any remaining particles to avoid clogging the tube. This means some fiber and potentially some nutrients will be lost, and it will be more time consuming. I still believe this method is superior to feeding an artificial formula. If it is the only way, it is still very good for your child. Both Blendtec and Vitamix offer a medical discount on their blenders for tube-fed people.
3. Do I have to wait until my child is 1? Not necessarily. Of course, prior to age one, a full blenderized diet of real food should not be used. Consider how orally-fed babies eat. Up until 6 months, they are typically fed only breastmilk or formula. After that, breastmilk or formula and pureed food are often what is fed. As the child grows closer to age 1, more and more food is often fed until age 1, when breastmilk or formula may be discontinued and a diet of only real food is used. There is no reason a tube-fed child could not follow this same time table.
4. I’m overwhelmed. Will you help me begin a blenderized diet for my child? Yes! Please visit here to see what I offer.
5. What do I do if I clog the tube? There is a great video about this here. I also recommend following her YouTube channel.
6. I talked to my child’s dietitian and was recommended Compleat Pediatric or Kate Farms. The dietitian said this was a blenderized diet. Is it? NO. Compleat Pediatric and Kate Farms are not a blenderized diet. It does have some real food in it. However, one of the primary ingredients is  brown rice syrup. No one sits around drinking rice syrup all day. It has an extremely, extremely high glycemic index, much higher than table sugar. If you wouldn’t eat or drink it, there is no reason to think your child should eat or drink it. Besides being high in refined carbs (and the companies that makes these formulas go to great lengths to make it extremely difficult to even find out how much sugar is in their formula, which indicates they realize their product is not ideal), Compleat and Kate Farms are exposed to extremely high temperatures, which dramatically influences the quality of the food in the formula and the available nutrients. Freshly blended is the best your child can have.
7. Are there any formulas made of real food? Yes, there are, actually, though I wouldn’t call them “formula.” There are 3 formulas made of real food: Liquid Hope, Nourish, and Real Food Blends. Liquid Hope is a plant-based, non-GMO, organic blend of real food intended for older children and adults. Nourish is made by the same company and is similar to Liquid Hope, but formulated for pediatrics. Either one is considered a complete meal with nothing required to add to it. Real Food Blends consist of various meals with a handful of ingredients in each. For example, one meal has juice, beef, spinach, and potatoes. If you use Real Food Blends exclusively, you need to add a multivitamin, a source of calcium and a touch of salt. Many people use these options as supplements to a home blended diet for long days out or during travel. These are both great options. However, a freshly blended diet of real food is the best you can give. These products are required by the FDA to go through a heating process to make them shelf stable. This means many of the natural vitamins and minerals are destroyed. Synthetic vitamins do not have the same health benefits as those naturally found in food. So, you cannot beat a home blenderized diet. However, these products are great to turn to when blending is not possible or desired, and I fully support their use.
8. My child’s dietian has suggested Compleat Organic Blends. What do you think of this product? Please read over the information I provide here.
9. My child’s dietitian has recommended Pediasure Harvest. What do you think of this product? Please read over the information I provide here.
10. What do I do if I’m scared? I was terrified. It sounded so overwhelming. And it very well may be at first. But, that does not mean it will always be overwhelming. You will find your way. It won’t be long before you’ll be looking back to your first days of BD and feel amazed at how much you’ve learned and how far you’ve come. You can do this! If you need additional help and support, check out Crunchy Coaching here to see if this would help you. Also, feel free to email me with basic questions at crunchytubiemama@gmail.com any time!