What is a fully blended diet?
A fully blended diet, also known as a blenderized or liquidized diet, involves pureeing everyday table foods into a thin, smooth liquid consistency that can be administered through a feeding tube, such as a gastrostomy. This practice offers an alternative to commercially manufactured enteral formulas (CEFs), which dominated tube feeding from the 1970s until recently. For many tube-fed individuals, particularly children, a blended diet provides an opportunity to incorporate real, whole foods into their nutrition, which may offer various physical and psychosocial benefits.
Unlike CEFs, which are scientifically formulated and sterile, homemade blended diets can be made from a wide variety of fresh, cooked, or canned ingredients, allowing for a diverse nutritional profile. It's crucial for caregivers and patients considering this route to work closely with a dietitian to ensure the blend is nutritionally complete and safe. Commercial blenderized formulas (CBTFs) are also available, providing a middle ground with standardized ingredients and nutrient profiles.
The Benefits of a Blended Diet
Parents and caregivers who choose a blended diet often report significant improvements in the tube-fed individual's well-being. The reported benefits include:
- Improved gastrointestinal health: Many users experience a reduction in symptoms like vomiting, retching, constipation, and reflux when transitioning from formula to a blended diet. The natural fiber content in whole foods is believed to contribute to better bowel function.
- Greater gut microbiome diversity: Some studies have indicated that children on blended diets show a more diverse gut microbiome, similar to that of their healthy, orally-fed peers, compared to those on commercial formulas.
- Psychosocial benefits: The ability to participate in family meals and consume the same food, albeit in a different form, can provide a significant sense of normalcy and reduce the medical burden of feeding for families. Exposure to the smells and tastes of real food can also be a positive sensory experience.
- Cost-effectiveness: While requiring an initial investment in equipment, homemade blended diets can be less expensive over time than purchasing commercial formulas.
- Customization: A blended diet can be tailored to an individual's specific dietary needs, preferences, and intolerances. This is particularly useful for managing allergies or adjusting nutrient density.
Potential Risks and Considerations
Despite the benefits, a fully blended diet carries specific risks that must be carefully managed with the guidance of a healthcare team.
- Tube blockage: If the blended food is not a completely smooth, thin consistency, it can clog the feeding tube. This is especially a concern with smaller diameter tubes like nasogastric tubes. Proper blending with a high-power blender and straining the mixture is crucial.
- Nutritional inadequacy: Formulating a nutritionally complete and calorie-dense diet can be challenging. If the blend is too dilute to pass through the tube, it may not meet the individual's caloric needs. Regular monitoring by a registered dietitian is necessary to ensure the diet provides adequate macro- and micronutrients.
- Food hygiene risk: Homemade blends are not sterile, unlike commercial formulas. Strict adherence to food hygiene and safety protocols during preparation, storage, and handling is essential to minimize the risk of bacterial contamination and food poisoning.
- Preparation time: Creating and preparing balanced blended meals requires a significant time commitment from caregivers, which can be a barrier for some families.
- Equipment lifespan: The feeding tubes and ancillary equipment may need more frequent replacement when using blended diets, as they are not specifically approved for this purpose.
Comparison Table: Homemade Blended Diet vs. Commercial Formula
| Feature | Homemade Blended Diet (HBD) | Commercial Enteral Formula (CEF) |
|---|---|---|
| Nutritional Composition | Highly variable; depends on ingredients and preparation. Requires careful monitoring. | Consistent, precise nutrient profiles verified for nutritional completeness. |
| Customization | Very high. Ingredients can be adjusted for allergies, intolerances, and preferences. | Low. Limited to the commercially available formulas and their variations. |
| Cost | Can be cheaper long-term, but requires initial investment in a quality blender and supplies. | High upfront cost for purchasing formula regularly, but covered by insurance for some. |
| Preparation | Time-intensive. Requires blending, potentially straining, storage, and reheating. | Minimal. Ready-to-use liquid; simple to open and administer. |
| Risk of Infection | Higher, if food hygiene practices are not strictly followed. | Lower, due to sterile, commercially prepared formulas. |
| Equipment | May require a more powerful blender and cause more wear on feeding tubes. | Designed for use with standard enteral feeding equipment. |
| Psychological Impact | High. Can increase a sense of normalcy and family participation in mealtime. | Lower. The process is more medicalized, with less sensory input from real food. |
Getting Started with a Fully Blended Diet
Commencing a blended diet requires careful planning and medical supervision. Before starting, consult with your healthcare provider and a registered dietitian to create a plan that meets specific nutritional needs.
- Choose the right equipment: A high-speed, powerful blender is essential to achieve a consistently smooth, thin puree that will not clog the feeding tube. Mid-range or stick blenders may require extensive sieving.
- Select balanced ingredients: Follow dietary guidelines, such as the USDA MyPlate model, to ensure a balance of fruits, vegetables, grains, proteins, and dairy (or alternatives). Examples include blended cooked meats, grains, cooked vegetables, and fruits.
- Ensure correct consistency: The final blend should have a consistency similar to single cream and easily flow off a spoon without any lumps. If the mixture is too thick, add more liquid, such as water or broth, rather than compromising nutritional density.
- Practice safe food handling: Adhere to strict food hygiene standards. Wash hands and equipment thoroughly. Label and date all blends, and store them in the refrigerator for no more than 24-48 hours or freeze them for longer storage.
- Fortify where necessary: To increase calorie density without adding volume, a dietitian may recommend adding energy-rich foods like oils, butters, or nut butters to the blend.
Creating a Balanced Blended Diet
To build a complete and healthy blended diet, consider incorporating a range of food groups. A dietitian can help tailor recipes to the individual's needs, but here are some examples of ingredients:
- Grains and Carbohydrates: Cooked pasta, rice, porridge oats, or fortified breakfast cereals can provide sustained energy.
- Proteins: Cooked meats, fish, eggs, tofu, legumes (lentils, chickpeas), or nut butters are excellent protein sources.
- Fruits and Vegetables: Fresh, frozen, or canned fruits and well-cooked vegetables offer essential vitamins and fiber. Always ensure skins and seeds are removed or thoroughly blended and strained.
- Dairy and Fats: Whole milk, yogurt, plant-based milk alternatives (fortified), cheese, or oils (olive, coconut) provide calories, calcium, and fats.
Regular monitoring of weight and nutrient status is critical, especially when relying solely on homemade blends.
Conclusion
A fully blended diet can be a viable and beneficial alternative to commercial enteral formulas for many individuals requiring tube feeding, offering improvements in gastrointestinal tolerance, microbial diversity, and quality of life. However, it is not a decision to be taken lightly and requires a strong commitment to proper preparation, nutritional planning, and hygiene to mitigate risks such as tube blockage and nutritional deficiencies. The key to a successful blended diet lies in close collaboration with a medical team, especially a dietitian, to ensure safety, nutritional adequacy, and the best possible outcomes for the individual. For those seeking further information, authoritative resources can be found through professional bodies such as the National Institutes of Health.
