Talking to your team about a blenderized diet

*I am not a doctor. I am not providing medical advice.*

You’ve done some reading, you’ve looked at formula ingredients lists, maybe you’ve talked to others who feed real food through a feeding tube, or maybe you’ve just realized that you’re human (or your tubie is a human) and there’s no medical reason you/they can’t eat food like all the other humans….

Image by silviarita from Pixabay

Now what?

Now it’s time to talk to your medical team. While some who feed real food do so without letting their medical team know, I personally believe it’s always best to keep your providers informed. However, the experiences of those who’ve made the switch to real food are so widely varied. Sometimes their medical providers are entirely on board from the start. Sometimes medical providers need a little convincing, but they’re willing to be tacitly supportive, if not actively supportive. And sometimes they’re just entirely resistant to the idea.

We’ve got your back, whatever happens. Keep reading for suggestions on how to start the conversation with your medical team, as well as some ideas on how to handle the response from your providers – whatever that response is.

My purpose here isn’t to talk you into a blended diet, or to provide you with research or factual information on the benefits of blended diets. I feel like Crunchy Tubie Mama does an excellent job of making the case for blended diets and providing tons of facts and research – I couldn’t even begin to duplicate that. Go check out her website, and consider joining the Blenderized RN group on Facebook.

Before You Even Think About Talking to Your Team

Do the research. Is it safe for you or your tubie to be fed food? Does your or your tubie’s condition have dietary restrictions? Do you know anybody with your or your tubie’s condition who eats orally? Does your hospital/your nutritionist, in fact, have patients with your or your tubie’s condition who eat orally?

How much do you know about nutrition? Do take some time to familiarize yourself with the basics of nutrition – even if you’ve been feeding oral eaters for your whole life. Get a sense of how many calories you need, how much protein/carbs/fat and where you might get those nutritents from, read up on how to ensure you consume a varied enough diet to make sure you’re getting sufficient quantities of the micronutriets, etc.

But while you’re doing all that, also consider that few American humans eat 100% of the RDAs of every nutrient every day. Some days, we oral eaters consume a LOT of Vitamin C, and other days not so much. Some days, we get enough calcium, some days we don’t. A little variety is pretty normal. Is it IDEAL? I don’t know. But I do know it’s TYPICAL.

Starting the Conversation

Don’t ask, tell. You’re not asking for permission. You’re informing your providers that you’ve made a decision and you’re letting them know. But you’re being very polite about it.

“I’ve been reading about using a blended whole foods diet with a feeding tube, and I plan to start doing that.” (If this feels too aggressive for you, you can go with a variation such as “and I’d like to start that,” but be careful not to say anything that at all sounds like you’re asking for their permission. You’re not.

From there, you can ask for their support and help. “Are there any specific dietary guidelines I should follow?”  or “I have a pretty good idea how I’m going to start, but if you have any suggestions, I’d definitely take them into consideration.”  (Notice the tone here – you’re taking what they have to say as advice, but you’re the one in charge. Notice that I didn’t type “Do you have suggestions on how I should start?” Important aside: be sure to have done enough reading by this point that you’re telling the truth when you say that you have a good idea how to get started.)

You’ll probably want to know what your calorie goal is, if you don’t already, and if there are any restrictions or requirements for your diet. (You can research this for yourself ahead of time – the internet is your friend here. How many calories would a typical person of your age, size, and weight goals consume? Do you have a medical condition that might impact this? Does your diagnosis have a Foundation of some sort, and does that Foundation have information on good dietary choices? For example, my kiddo is a kidney transplant recipient, and the National Kidney Foundation is a great source of information about nutrition specific to kidney disease.)

A good question to ask of your medical providers is “what would you recommend for oral eaters?” Remember, you’re going to be feeding the same diet you (or your tubie) would be eating if you (or they) were doing it by mouth – so you can follow the same advice they would give those eating with their mouths.

You could ask how many patients they have feeding a whole foods diet. “How many other patients in this clinic are using a blended diet, that you’re aware of?”

Above all – stay positive and upbeat here. You’re excited. You’re happy. You’re enthusiastic. You’re not going to let any nay-saying discourage you.

Bonus hot tip. Don’t use the word “internet” or, especially, “Facebook,” unless your provider is supportive right out of the gate. These words too often cause providers to assume you got your information from Uncle Bobs Info N Stuff dot com.

Push Back Against the Ignorant Advice and Concerns

On this specific subject, it’s like providers lose their minds sometimes. You might hear “a blended diet sounds great, but we’re too worried about clogs for that to be a viable option.” With a quality blender and the right technique – and sometimes using a strainer – clogs are rarely a problem. Assess this concern for your own situation. If you have a button, for example, and you DO clog it up to the point that it can’t be fixed, it’s a simple matter to swap it out at home. This is not a big deal. (And bear in mind that MOST clogs can be avoided or fixed.)

Another one is “oh, that sounds great, but your feeding tube is just too small for this to work.” Yes, this might be a valid concern, but chances are it isn’t. Most people over the age of 1 have a tube that’s big enough to handle real foods.

Or how about “a blended diet is too risky from a bacteria standpoint – formula is sterile.” Yes, formula is sterile until the jar’s opened, then it’s just like everything else. Are you using sterile feeding tube supplies (the feeding pump sets are not sterile)? Likely not. You’re using CLEAN supplies. If there are people with your diagnosis eating food orally, sterility likely isn’t a legitimate concern. Reassure doctors that you’ve cooked food before, you know basic food safety rules, and you’ll always always use an ice pack if you’re going to have your feed out for longer than an hour. (And then actually do all that, there’s no reason to give yourself food poisoning and then look like an idiot in front of your doctors.) (We’ve got some awesome products to help you out with this – insulated feeding pump bag covers, insulated syringe totes, etc.) If it would help your providers feel better, they can go over food safety with you.

If your Provider is on Board

That’s great! Ask them for resources. Ask them for guidelines on nutrients. They could hook you up with prepackaged blended foods (Nourish or Real Food Blends). They can help.

If your Provider needs Convincing or is Reluctant

You can approach this a few different ways. You can just get started and let them come along for the ride. Or you could try to talk them into being supportive. I personally tend to go path of least resistance on many things, and in this case I personally would just go ahead and let them come along for the ride, but if you want to bring in research, or ingredient lists, or maybe compare the nutrient info of their recommended formula against the USDA’s recommendations… go for it. Note, I’d try to avoid committing to following any specific recipe. A commitment to START with their recipe, fine. But don’t back yourself into a corner on this one. I’ve seen so many hospital-provided blended diet recipes, and it’s difficult to believe they were written by people with college degrees related to food. Don’t lock yourself into using these formula-duplicates.

If your Provider is Completely Against the Idea

This is tricky. I cannot tell you what to do, but you still have options. I decided, for us, to just do it anyway. I told them I was going to start giving real foods, let the subject go, started giving my child bits of baby food, and then let them know a few months down the road how it was going. I 100% knew that food was safe for my child, and I knew the dietary restrictions that went along with his condition. Another option is to find new providers. If you have other providers available – even if you have to drive a bit more – this might be better in the long run. I certainly don’t think any doctor who won’t support me in something like wanting to feed real food instead of chemicals, sugar, and oil is really worth my time or my money. We faced a bit of a battle at first with our providers, but they came around pretty quickly once we got started. We would not still be with them if they hadn’t.

Please note, I do not ever advocate LYING to your providers. About anything.

Does your Provider Have a Valid Point?

Some people truly are not candidates for using real food. FEW people, but it’s not outside the realm of possibility. If your doctor seems to truly believe real food isn’t an option for you, you need to evaluate what they’re telling you. Be sure to get a clear answer about WHY you can’t have real food. If it’s due to your diagnosis, are there others with your diagnosis who eat real food (with their mouths)? What would they recommend if you were oral eating?

This is definitely something that requires a second opinion. Ask other blended diet users (not your doctor) to recommend blended diet friendly doctors in your vicinity, and make an appointment for a second opinion before making any final decisions.

HOPEFULLY at this point, your providers are at least tolerant of your blended diet ways, and you’re well on your way to experiencing the joy of blending up just plain ol’ food for your feeding tube! Enjoy!

http://bit.ly/blendeddiet

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Blended Diet Hacks

Have you decided to blend up real food for your feeding tube, or for the tubie in your life, instead of using commercial formulas? This is usually a harder path to take, without a lot of support from medical personnel. Here are some tips your nutritionist or doctor probably didn’t tell you – and probably doesn’t know.

1. Modify the Bag

If you run your blended food through a feeding pump, first, choose an Infinity pump. Infinity works SO MUCH better for blended diets than Kangaroo. Second, if you’re experiencing a lot of alarms and troubles getting the feed through the pump, modify the bag by snipping off the flow limiter.

Look at the cartridge part of your feeding set (the hard plastic part with the blue). One of the blue tubes has a picture of a drop of water on it. Pull that off. Underneath, you’ll see what’s in the picture. See the part I circled? It’s like a little knob? Cut, snip, or break that part off. (I prefer to just bend it back and forth until it breaks off.) Reassemble the cartridge. Voila.

2. Cap your syringes

We wrote a whole blog post about this! Many 60 mL syringes don’t come with caps, which is a shame. But you can use old extensions (clamp them shut near the part that connects to the syringe, cut off the extra) or even the caps from your feeding sets, if you also use a pump.

3. Insulated Tote To Safely Carry Filled Syringes

Wallypop's syringe tote

Formula is much easier to carry around. It’s shelf-stable. But actual food isn’t – particularly not when blended up. Many feeding tube users find they prefer to carry their feeds already drawn up into syringes for feeding on the go, rather than carry a single syringe and a jar or bottle full of food. Refilling syringes can get messy and usually requires more of an interruption to your day, whereas bringing prefilled syringes reduces the hassle factor quite a bit. If you find you prefer toting prefilled syringes, our Syringe Tote is for you. I’m so excited about this newer addition to my line of feeding tube accessories! It’s double-insulated, has two large compartments inside, and one small compartment, and it’ll hold 5-6 60 mL full syringes plus an ice pack and small accessories like a 20 mL syringe, Gtube cushions, a few predrawn liquid medications, etc.

4. Know your extension

shows three types of extensions

Some people feed their blenderized diet directly into the button using a slip tip syringe. Some people prefer to feed through the more typical Y-Port extension. But many tube feeders prefer one of the two single-port (or bolus port) extensions – the right-angle bolus extension or the straight bolus extension. I personally prefer the right angle bolus extension for pump feeding (no med port to pop open) and the straight bolus extension for syringe feeding (requires less pressure, in my opinion). Get a few of each from your DME and see what you like.

5. O Ring syringes

a miracle syringe

Regular rubber-plunger syringes stop working after a VERY short period of time. Many blenderized diet users prefer syringes with an O-ring instead, such as the Miracle Syringe. These syringes are often sold by stores that cater to squirrel rehabbers. O-Ring syringes are also sometimes available through DME suppliers, so be sure to ask before you pay out of pocket. Miracle Syringes are Catheter-tip, but you can also get adapter tips to make them into a slip tip if you prefer to feed directly into the button, without using an extension. If you use EnFit, NeoMed makes O-Ring EnFit syringes that you can get through your DME or online medical supply stores. Why bother with getting an O-Ring syringe? They last forever and glide like an Olympic ice skater. I bought a handful of syringes in 2013. I still use them. They still work like a dream.

6. Oil Syringes

If O Ring Syringes aren’t an option for you, you might notice that the rubber plunger syringes provided by your DME start to stick after a very brief period of time. Putting some oil (olive, coconut, any food oil) on the plunger will help keep it sliding smoothly – some people prefer to dip the entire plunger in oil, while others prefer to just slide a few drops down the inside of the syringe.

7. Don’t open RFB all the way

If you use Real Food Blends, don’t open the packet completely! If you’re filling syringes, just open a corner of the packet, and stick the syringe in. If you’re filling a feeding set (bag), just open a corner of the packet and you’ll have more control over where that food goes – and it’ll be easier to squeeze out every last bit.

8. Get a longer hang time with an insulated bag cover.

So many nutritionists and doctors shoot down the idea of a blended diet solely on the basis that the food can’t hang at room temperature for long. And they’re right – it can’t. But it’s like they’ve never heard of insulation and ice packs. Insulated covers plus an ice pack for your feeding sets allow you to have a longer safe hang time – even all night without having to refill. They also will let you carry a feed all day at a safe temperature without having to refill. These really make tubie life just so much easier.

9. Fill pouches with syringes, Fill Syringes with Pouches


Some blended diet users like using baby food packets (either single use or resuable) to carry their blends. Yes, some makers of empty baby food packets sell fancy, expensive equipment to fill the bags, but you don’t need that. You, you lucky tube feeder, have access to syringes! Use your 60 mL syringes to fill the pouches. And then when it’s time to feed, if you push with a syringe, do the reverse – stick the tip of the syringe in the pouch’s opening and pull back on the plunger while gently squeezing the pouch from the bottom up. Easy, and no mess!

10. You do You: junk food, batch/meal, healthy, regular diet

There are so many ways to tube feed, and so many ways to approach a blended diet. You do what works best for YOU. Don’t worry about what Suzie on Facebook does. If you/your tubie doesn’t have any special dietary needs, and if they’d be eating a typical diet if they didn’t have a tube, there’s no reason you HAVE to do anything special just because they DO have a tube. Even with most dietary restrictions, most oral eaters don’t create spreadsheets to manage their daily intake.

If you want to feed chocolate cake through the feeding tube (and there aren’t any legitimate medical reasons not to), go for it. Regular people eat junk food occasionally, and tubies are just regular people who eat via a different route. Does it make more sense to you to bland up a whole day’s worth of food at once? Or a whole week’s? A whole month’s? Do it (use safe storage methods). Does it make more sense to you to blend per meal, just blending up what you’re cooking for everyone else, or what you’d typically cook for yourself? Do it.

Do you want to have your blended diet be super healthy? Go for it. Do you want to serve just a regular, every day, American diet? Go for that. Do you want to make a huge spreadsheet to track every calorie and every micronutrient? Do it! Do you want to never ever do that? Unless there’s a medical reason you need to, don’t!

*obviously, a certain portion of tube fed people DO have dietary restrictions, ranging from issues with food allergies to needing a renal diet, to being unable to digest most foods. Please use your common sense here.

11. Squeasy Gear

I don’t personally use Squeasy Gear, so I can’t provide any sort of personal recommendation, but many blending families swear by it for easy storage and portability of blended feeds.
graphic showing squeasy gear benefits.

12. Sharpie scrubs off glass

If you store your blends in glass jars, use a sharpie to label them. So many people try to use crayon, or stick on labels, or dry erase marker. Just use a sharpie. It won’t rub off… but when you wash the jar, your kitchen dish scrubby will take it right off.

5 Blenderized Diet Must-Haves

Many feeding tube users and parents of feeding tube users have discovered the numerous benefits of a blenderized real food diet. Thinking of starting a blenderized diet? Already taken the plunge? You’ll want these five must-have items.

      1. A Good Blender. Most people who use a blenderized diet prefer a BlendTec or a Vitamix and find that straining the blends isn’t necessary with these blenders like it can be with other brands. I personally have used a BlendTec for 6 years now and LOVE IT. Follow the instructions for what order in which to add food, make sure there’s enough liquid to get a good vortex, and run it twice on soup. Boom. These blenders are pricey; check with the manufacturers about the availability of refurbished machines.
        a BlendTec blender
        .
      2. Nice syringes. Regular rubber-plunger syringes stop working after a VERY short period of time. Many blenderized diet people prefer syringes with an O-ring instead, such as the Miracle Syringe. Oddly enough, these syringes are often sold by stores that cater to squirrel rehabbers. O-Ring syringes are also sometimes available through DME suppliers, so be sure to ask before you pay out of pocket. Miracle Syringes are Catheter-tip, but you can also get adapter tips to make them into a slip tip if you prefer to feed directly into the button, without using an extension. If you use EnFit, NeoMed makes O-Ring EnFit syringes that you can get through your DME or online medical supply stores.  Why bother with getting an O-Ring syringe? They last forever and glide like an Olympic ice skater. I bought a handful of syringes in 2013. I still use them. They still work like a dream.
        a miracle syringe
        .
      3. Extensions. Some people feed their blenderized diet directly into the buttom using a slip tip syringe. Some people prefer to feed through the more typical Y-Port extension. But many tube feeders prefer one of the two single-port (or bolus port) extensions – the right-angle bolus extension or the straight bolus extension. I personally prefer the right angle bolus extension for pump feeding (no med port to pop open) and the straight bolus extension for syringe feeding (requires less pressure, in my opinion). Get a few of each from your DME and see what you like.
        shows three types of extensions
        .
      4. Storage for your blends. There are many different ways to accomplish a blended diet. Some people prefer to blend by the meal, so they cook breakfast and blend it up, then cook lunch and blend that up, make a snack later, then dinner. If that’s you, you have no storage needs. Others prefer to blend either one time for the whole day, for once for a couple of days, or once for a week or two. If that’s you, you need a good way to store your blends. You have so many options. Our family blends every 2 weeks, and I freeze blends in glass jars (leave plenty of headspace, don’t crowd the jars in the freezer, and don’t screw the lids on until frozen). Other families prefer to use any variety of plastic containers. Some use breastmilk bags. A relatively newer product on the market that is a favorite with many blending families is Squeasy Gear.
        graphic showing squeasy gear benefits.
      5. A way to keep your food safe on the go. Formula is much easier in this regard. It’s shelf-stable. But actual food isn’t – particularly not when blended up. Many feeding tube users find they prefer to carry their feeds already drawn up into syringes for feeding on the go, rather than carry a single syringe and a jar or bottle full of food. Refilling syringes can get messy and usually requires more of an interruption to your day, whereas bringing prefilled syringes reduces the hassle factor quite a bit. If you find you prefer toting prefilled syringes, our Syringe Tote is for you. I’m so excited about this newer addition to my line of feeding tube accessories! It’s double-insulated, has two large compartments inside, and one small compartment, and it’ll hold 5-6 60 mL full syringes plus an ice pack and small accessories like a 20 mL syringe, Gtube cushions, a few predrawn liquid medications, etc.
        Wallypop's syringe tote
        .
        .