Myths of blended tube feeding and the secret to getting your healthcare team on board

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If you have a feeding tube and you use commercial synthetic formula, maybe you’ve thought about blended tube feeding. And with good reason!

You got excited when you heard about blended tube feeding because it meant your GI symptoms could improve, you could have more variety in your diet, and you could make meals with your family again.

But when you asked your healthcare team about the option of a blended diet for your tube feeding, they were less than supportive. Why is that?

Blenderized tube feeds can bring lots of benefits but they may also bring some potential risks IF you don’t take steps to minimize those risks.

If your healthcare team has heard about blenderized tube feeds, they may have heard about some potential risks. 

If they haven’t heard about it, then they may not feel like they know enough to support you. 

I’m a registered dietitian, and tube feeding expert in support blended tube feeding. If you want to try blended tube feeding, I’ve got you!

I’m going to break down these myths of blended tube feeding so you can talk to your healthcare team about your choices and get them on board. 

What is blended tube feeding?

You may hear it called different things – blenderized tube feeding, blended diet, homemade blended tube feed, or liquid food for tube feeding. I’m sure there are more too!

But essentially blended tube feeding refers to blending food and liquid to a smooth consistency, thin enough to go through a feeding tube.

It DOESN’T have to be all or nothing! 

You have OPTIONS.

Blenderized diets can be individualized to suit your needs. Your plan can be adjusted depending on whether you can eat by mouth or not, how much nutrition you need through your feeding tube, and your particular nutrition needs.

Your healthcare team is always trying to care for you with your best interest at heart – So why are they so worried about you using real food to nourish your body?

Talk to your healthcare team about blended tube feeding

Your healthcare team may have heard about some potential risks related to a blenderized diet which is making them hesitant to support you in trying blended food for your tube feeds.

I’m going to challenge those perceived risks and tell you why they are more like myths of blended tube feeding.

They probably just haven’t been taught about it so they are “playing it safe”. 

It’s not something that they teach in school when you become a doctor or a dietitian (I think this will change). 

But the truth is that lots of research is being done on blenderized tube feeds, and it’s being driven by people just like you and me, who want to use real food for tube feeds.

And guess what – it’s safe when done right. 

You can thrive on blenderized tube feeds!

Lead with curiosity and start by asking your team if they’ve heard about blended tube feeding. 

If they’re hesitant, ask them if they can give you reasons why. 

Ask if they’d support you doing a trial, with a plan to check how it’s going and adjust if needed.

Let them know you’ve done your homework and you know what you need to do it safely.  

If they have concerns, it will likely be one of these myths of blended tube feeding that I’m going to cover.

Blended tube feeding myth #1: Can’t meet nutrition needs

Let’s look at how standard commercial formulas differ from blended food to address the first myth of blended tube feeding – that you can’t get the nutrition your body needs.

Synthetic commercial formulas

Something may have occurred with your health that requires specific nutrients or a change in nutrients. 

If you are admitted to the hospital urgently and you are very ill and unstable, your team may want to know exactly what nutrition your body is getting. Standard formula allows them to know what you are getting and regulate it to support your recovery. 

It may be better for your recovery if nutrition is very regulated and you’re getting a formula that is standardized, consistent, and easy for your body to process. 

Commercial formulas (synthetic or blenderized food) are standardized so your healthcare team can easily calculate exactly how many macronutrients (carbohydrates, protein, fat) and micronutrients (vitamins and minerals) you are receiving. 

Sometimes knowing exactly what you are receiving is very important – like when you are critically ill.

Blended tube feeds

BUT – Sometimes it’s not necessary to know exactly what nutrients you are receiving and it’s okay to rely on receiving a variety of foods through your feeding tube (as you would if you were eating by mouth).

If you were eating, your team would not have the exact nutrition counts and they would have to rely on you reporting what and how much you were eating. 

Instead, your team can monitor how you are doing with things like healing, how you can carry out your daily activities, or how your weight fluctuates, for example. 

If you’re considering a blended diet, it’s important to be open with your healthcare team so they can help ensure you are considering all your nutrition needs for your situation and personalize a plan for you.

Get the help of a registered dietitian

Everyone has different needs, and you’ll need a plan tailored to you, which is why you should have a registered dietitian to help you with your tube feeding plan. 

A registered dietitian will work with you to develop a plan that fits your lifestyle, meets your nutrition needs, and minimizes any risk to your health.

When I work with clients, I consider your nutrition needs and lifestyle, health goals, and resources – so you can successfully incorporate blenderized tube feeds

I wouldn’t make you eliminate the commercial formula either if that worked for you and your needs.

We come up with a personalized plan that meets your needs and that is realistic for you to keep up with.

Your feeding plan may change over time as you get more comfortable and efficient with blending.

You can rest assured that you’ll have someone in your corner, helping you every step of the way.

If you’ve got your nutrition needs met, what else could your team be worried about?

Blended tube feeding myth #2: More likely to clog your tube

Next myth of blended tube feeding? That it is more likely than formula to clog your feeding tube.

A blocked feeding tube can mean interruptions to getting your nutrition, more trips to the doctor’s office or hospital, and a procedure to get it replaced if you can’t get it unblocked.

No one wants this to happen. So let’s talk about how to prevent blockages with blenderized tube feeding.

Check your tube size

One thing to find out is the size of your feeding tube. General recommendations have been to have a tube size bigger than 14 French (F) (1, 2).

But that being said, people with smaller tubes can use blended food, with a few precautions.

If your feeding tube is smaller than 14F, you should talk to your dietitian. It may be more difficult to get what you need if your food has to be thinned to go through your smaller tube.

This is when a combination of formula and blended food could be used to give you some benefits of real food while also making sure you are meeting your nutrition needs. 

Being open with your dietitian is important so you can discuss your particular situation and consider your individual needs. 

Do you have an established feeding tube?

If you just got your feeding tube put in, your healthcare team may ask you to wait to try a blended diet. 

This is because they want the opening (stoma) where your tube goes in (stomach or bowel) to be properly “established” or healed (1, 2).

If you happen to get a blocked tube and it needs to be replaced, it’s better if your “stoma” has had a chance to get established. It makes the process of replacement easier.

Find the right blender (and maybe a strainer)

If you want to give a blended diet a try, start with a regular kitchen blender and a fine mesh strainer. 

Blending with a regular kitchen blender will sometimes require you to take the extra step and strain your blends. Straining your blend will help to ensure there aren’t any particles left that could risk blocking your tube. 

Using softer ingredients and avoiding coarse nuts and small seeds is a good idea if you don’t have a high-powered blender.

You may also need to blend the food longer (3-5 minutes) to get a smoother consistency (3).

Stronger, high-powered blenders will be a good investment if you decide to blend most of your food but you don’t NEED one to get started.

High-powered blenders tend to be better for making even coarse meats, nuts, and seeds smooth and easy to go through a feeding tube and minimize the risk of blockage. Their motors are meant to last with the intense blending you will be doing to make your blended tube feeding.

If you have a smaller tube (less than 14F) you may still want to strain your blend to ensure there aren’t any particles to get stuck.

Flush your feeding tube regularly

Just as you do with a standard formula, it is important to flush your tube regularly with water. 

Proper flushing can be your best defense against a clogged feeding tube (4).

Water flushing ensures that no food or medication is sitting in one spot in your tube and forming a clog. It also helps to keep medication and formula or food separated, which also contributes to tube blockage. 

You should always begin and end your feed with a water flush (4).

Work with your dietitian to figure out how much water is right for you and then how many water flushes you need.

I wrote another blog article detailing how to deal with a clogged feeding tube and preventing future blockages – check it out here. I also have a free downloadable checklist for you to keep handy for those panicked moments dealing with a clog.

Let’s break down one last myth of blended tube feeding that’s holding back your healthcare team.

Blended tube feeding myth #3: You’ll get food poisoning

Just as someone preparing food to eat by mouth, you must be aware of proper safe food handling to reduce your risk of foodborne illness with blenderized tube feeding.

Foodborne illness or food poisoning happens when you eat food contaminated with bacteria, a virus, or a parasite and you become sick. You can experience diarrhea, vomiting, stomach cramps, and fever (5).

In the context of this article, we’re talking about getting sick from the food you put through your feeding tube. 

When you follow proper food safety and cleaning practices, you can safely use blended food for tube feeding (6, 7).

Let’s review some food safety and proper cleaning for blended tube feeding. 

Safe food preparation and handling

You should wash your hands with warm water and soap before and after food preparation and before tube feeding. 

You should also wash your work area, utensils, and cutting boards with hot, soapy water (8).

Separate raw meat, eggs, poultry, and seafood from ready-to-eat food. This includes when you’re shopping, transporting, storing, and preparing these items.

Cooking food to appropriate internal temperatures is important to kill germs that can make you sick. 

Use a food thermometer to check internal temperatures are reached and that food is safe to use for tube feeding. You can find a detailed chart with food temperatures here.

When I took food safety classes, I remember the saying, “Keep hot food hot and cold food cold”. This means keeping food out of the “danger zone” between 40 degrees Fahrenheit (F) and 140 degrees F (8).

Bacteria can multiply quickly when in the “danger zone”, so you want to minimize the total time that food spends in this zone.

Refrigerate foods promptly to minimize time in the danger zone.

When thawing frozen foods (or pre-prepared blends), thaw them in the fridge or the microwave. 

This will avoid having parts of the food or blended formula at room temperature or in the danger zone for long periods while the rest thaws.

Proper cleaning of bags and syringes

Wash your blender and any storage containers and feeding equipment thoroughly in between uses. Follow the manufacturer’s guidelines for washing and sanitizing.

If there are not any specific guidelines for sanitizing your feeding equipment, it is recommended to follow the CDC guidelines for cleaning feeding equipment. 

The CDC guidelines recommend a bleach solution of 1 tsp unscented bleach per gallon (16 cups) of water in a clean basin. 

You then soak the items, fully submerged in the solution for at least 2 minutes.

Then remove the items and let them dry (do not rinse) (3).

Sanitizing would be especially important for someone who is immunocompromised. 

Hang times, method of feeding

The maximum recommended hang time (or time that your food is at room temperature) is 2 hours (remember the “danger zone”) (3).

Blenderized tube feeding is best suited for someone using a bolus method with syringes or gravity feeding bags as it is a quick method of feeding. Bolus feeding means your food isn’t sitting at room temperature for long before you are using it.

If you use a feeding pump and have longer feeding times, it may be harder to coordinate using blenderized tube feeding (but not impossible). You may be able to alter your schedule depending on your tolerance to blended tube feeding.

Commercial blenderized formulas have a longer hang time than homemade formulas, so that could also be an option for you if you want to include a food-based formula.

It’s worth discussing with your team to see how your feeding schedule can be modified to help you try blenderized tube feeding.

Some people find that they can tolerate blenderized food faster than when they use synthetic commercial formula.

Discuss benefits and risks and be open with your team

It’s important to be open with your healthcare team about your values and desires around your health and feeding.

If blended tube feeding is something you want to try, start a discussion with your healthcare team. Talk about how it could benefit you and how they perceive the risks for your particular situation.

They may have only heard about these myths of blended tube feeding as more of risks and not have the full story. Feel free to share this article. It may help generate discussion about what you want for your nutrition plan and how they can support you using blended tube feeding safely.

Blended tube feeding can have some great benefits such as improvements in GI symptoms, increased variety in your diet, and diversity in your gut bacteria, 

Not all the benefits are nutritional. There are also psychosocial benefits such as participating in grocery shopping, family meal preparation, and togetherness at the table.

You can read more or direct your healthcare provider to read more in a previous article I wrote on assessing if blended tube feeding is right for you and the many benefits here

If your healthcare team knows your goals for your health, they can be a better support for you!

If this resonates with you and you want an experienced dietitian in your corner, consider signing up for my newsletter, and let’s stay in touch (no spam ever, I promise).

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