Blenderized Tube Feeding (BTF) is a growing trend where individuals use blended whole foods for tube feeding, driven by a desire for more natural and personalized nutrition. This presentation explores its prevalence, benefits, challenges, and practical implementation for both patients and clinicians.
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welcome everyone thank you for joining
us today for the Olli foundation webinar blenderize
blenderize
to feeding thank you again for joining
us my name is Andrea Guidi I am the
executive assistant for the Olli
foundation most of you are probably
familiar with the Olli foundation but
just in case this is your first
experience I'd like to briefly introduce
the organization the Olli foundation
strives to enrich the lives of those
living with home nutrition support both
intravenous nutrition sometimes called
hpn or TPN and tube feeding we do this
through education outreach and
networking the holy foundation was
founded in 1983 by dr. Lynn Howard and
her patient Clarence Olli Oldenburg
today we serve approximately 17,000
members all of our programs are free of
charge for patients and their families
first we'll go over a few housekeeping
details you should see a toolbar on the
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presenter please note we will not be
responding to the hand-raising function
in the control panel we will answer as
many of the questions as possible during
the questions and answers period at the
end of the presentation we'll post a
recording of the presentation and
handouts after the webinar on the Oly
website please note that we have muted
all the participants so you don't need
to worry if there is background noise
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you are having technical issues please
go to the Citrix website at the address
on your screen now for the presentation blenderize
blenderize
tube feeding btf is becoming a more
popular option for two fed patients both
adults and pediatrics lisa will discuss
prevalence of the use of btf as well as
discuss tools needed to blend at home
and how to create homemade recipes the
pre-made whole food formula
for both adults and pediatric will be
reviewed it gives me great pleasure to
introduce today's presenter we set up
Lisa is a registered dietitian
nutritionist at Mayo Clinic in Rochester
Minnesota she received her Bachelor of
Science degree from University of
nebraska-lincoln in 2003 and completed
her Dietetic internship at Mayo Clinic
in 2004 she is a member of the Academy
of nutrient and Dietetics as well as
American Society of ntral and parenteral
nutrition she is an assistant professor
in nutrition Mayo Clinic College of
Medicine and a home enteral nutrition
coordinator her interests include
enteral nutrition in pediatric and adult
patients blenderize to feeding and
speaking at state and national
organizations such as the American
Society of ntral and parenteral nutrition
nutrition
clinical nutrition week Academy of
Nutrition and Dietetics food and
nutrition conference and with the only
foundation we are thankful to have you
presenting today Lisa and I will turn
the presentation over to you now all
okay well thank you for that
introduction we have a lot to get
through today and I'm gonna do my best
to get through a lot of the questions
that were turned in ahead of time so I'm
gonna kind of go quickly through the
objective since you mentioned those
already and kind of delve right into the
first question that we have is who is
using blenderize feeding at home so
these are just some photos of some of
our patients we sent cameras home with
them and said show us what you do at
home because I bet it's different than
kind of the ideas that we're getting
which really opened our eyes to look at
you know maybe patients are kind of
coming up with things on their own at
home that we're not aware of so this led
us to our first kind of survey of our
own patients
to kind of ask them are you using
blenderize to feeding at home and our
survey was given to 30 of our home ntral
nutrition patients and of those 30
patients we found about 55 percent of
them said yes i'm putting something
other than commercial standard formula
water and medications through my tube
but the most important thing that we
learned is that 90 percent of them
express the desire to do blenderize tube
feeding if they had adequate information
to do so the other thing that we learned
from this survey is that of these
patients that responded they responded
when they used blenderize tube feeding
that they had no GI symptoms 83 percent
of the time and on a commercial formula
had no GI symptoms only 67 percent of
the time so that made us think okay well
commercial formula is at least or
blenderize tube feeding is at least as
well tolerated as the commercial
formulas that our patients are using so
we further ask them some more questions
and one of the questions was why are you
doing this and the most common response
was that they felt like it was more
natural and the reason why they weren't
doing it is because they weren't really away
away
of it so people looked at this survey
and said well your patients are pretty
savvy i bet more more of your patients
are doing home blend rice feeding than
maybe other patients out there so we
decided to provide the exact same third
survey through the Olli foundation and
got respondents both pediatric and
adults and we broke those into two
categories so for the Pediatrics we had
125 respondents and found that almost
90% of the people that responded to the
survey were getting blender ice tube
feeding for an average of 71 percent of
their daily calorie intake and
seventy-five percent of them were making
homemade blends and 25 percent were
using a commercial blender ice product
one thing that was important that we
noted here is that 90 percent of the
pediatric patients were not losing
weight when they were using the blender
ice formula compared to around 59
percent said that they weren't losing
weight so quite a with commercial
formulas so quite a few more kids not
losing weight with the use of blender
eyes feeding so then we looked at the
adult population and again
Oly foundation savvy consumers expected
there to be a higher percentage of
respondents using blender eyes feeding
and here we see obviously less than in
the pediatric group so 66 percent of the
adult patients that responded said they
were using blender ice tube feeding for
about 50 percent of their daily intake
but quite a few more were using some of
the commercial blender ice products only
67 percent were using homemade blends
and kind of the same trends here you
know reporting less weight loss with the
use of blender eyes feeding versus
commercial formulas so when comparing
those statistically there was a
significant showing us that using
commercial entró formula was more likely
to lead to weight loss than using
blenderize formula so we looked at those
two surveys the Mayo patients and the
Olli patients both pretty savvy savvy
groups and said okay but we want a
bigger bigger broader population of
respondents and so we were able to get
about 1,500 respondents to the same
survey and this time it was linked not
only on the Olli Foundation website the
feeding tube awareness foundation
website but also quorum and pediatric
home services to home medical equipment
companies helped helped us get the word
out about our survey to some of their
patients that might not be part of one
of the two groups that I mentioned which
allowed us to get a lot bigger
population but also hopefully a little
bit broader population and when we broke
to those two groups the pediatric group
reported about 24% using blenderize tube
feeding and the adult group about 15%
which we feel is probably closer to kind
of those averages that are happening out
there in the general population this was
presented as an abstract at clinical
nutrition week a couple weeks ago
however we have thousands of data points
that we learned from this survey that we
hope to publish in the very near future
so kind of looking at that that tells us
ok peep people are definitely doing
blenderize feeding at home both
pediatrics and adults so the takeaway is
that really for the clinicians that we
might be losing our patients if we're if
we are refusing to help create recipes
because they might be going to non
clinicians or just trying to figure out
on their own how to create home blended
recipes so I really would encourage this
to become part of a nutrition assessment
where you're asking okay you told me
you're taking X formula this amount of
water these medications do you put anything
anything
through your feeding tube like smoothies
or blended fruit or Gatorade or anything
like that just to get the story started
and help build that rapport when we
start those cameras that I mentioned
home with our patients um these were
some of the responses that we got back
you have brought the joy of cooking back
into my life I really like it it makes
me feel more normal I have more energy
with blenderize feeding and more regular
bowel movements and I have felt the best
I have in 10 years so when you're
hearing responses like that from
patients it's really difficult for us to
say no you cannot do this so what is the
appeal I think the general population is
really looking at our food supply and
they're wanting to look on labels for
ingredients that they can understand and
ingredients that they probably have in
their own kitchen they're wanting
personalized nutrition maybe avoiding
certain ingredients or allergens using
cooking for their family member as
nurturing or being able to feed their
family member the way that the rest of
the family eats whether it be vegan
organic non-gmo
or tomatoes from the garden in summer
families are wanting everyone all of
their loved ones to get that kind of
nutrition so let's talk a little bit
about the clinical benefits we're going
to talk a little bit about food allergies
allergies
some of the GI benefits in terms of
improved reflux bowel regularity bowel
abdication and the gut microbiota which
is kind of one of those hot topics in
nutrition right now
but also I cannot stress enough the
building patient rapport kind of those
looks of what are you doing and why are
you doing this and I don't want you to
do this still happen and that's
understandable because we're still
learning however really encouraging you
know providers and clinicians to be open
to hearing what is it that your patient
or family member once out of out of
their nutrition so let's start with the
GI and tolerance
studies so kind of the first study that
ever really showed us part of you know
increasing or improving symptoms with
using formula with real food ingredients
was in which thirty-three children who
are given blenderize feeding and you can
see here that they had a reduction of
gagging overall GI symptoms improved no
child had worsening symptoms and it
really did lead to increase oral intake
so really what we're looking at with
some of these studies is you know
studies that have gone through the peer
review process and that were done on
large groups and you can see as I go
through these these are very small
groups so even though we do have some
studies they are they are small and and
we're still hoping for those large
randomized control trials to to help us
make more clinical decisions so kind of
moving through these the next study that
I'll talk about here is with ten
children who had a mean small bowel
length of about forty eight centimeters
and they were given formula with real
food ingredients and nine of the ten
children were able to transition off an
elemental formula hand and had an
improvement of schooling which in this
case meant less diarrhea easier to
control hydration and the last one I'll
mention here was a group of 18 infants
that had diarrhea that were randomized
to either blenderize to tube fitting or
a semi elemental formula and in the
group that were given the blenderize
tube fitting diarrhea was better and
those infants had better weight gain
than the ones that had the semi
elemental formula so again small studies
but they are kind of all we have right
now so moving on to a pilot that we did
here with adult patients nine patients
were given blenderize tube feeding their
GI symptoms in this population were
similar to those who were on commercial
formulas none of the patient had a tube
site infection or symptoms of foodborne
illness and those with the normal BMI
gained weight a few of the patients with
the BMI greater than 30 did lose weight
but that was intentional this last study
was one that I was not as familiar with
that I came across more recently which
actually was not even a study about
blenderize tube feeding it was a study
about looking at the gut microbiome of a
group of elderly who were living in a
long-term care facility and so the
researchers looked at stool cultures of
178 elderly and they really put them
into two two groups based on what their
intake was and what they found was that
there was a much healthier diverse
amount of good bacteria in patients who
had a varied diet who ate well who had a
variety of foods and that the group that
were on a single formula every day had
the least amount of healthy bacteria in
their gut and the researchers concluded
that a single formula could contribute
to long-term ill health and the elderly
because it was not adequately feeding
the gut microbiome so what is the
hesitation and I think you know even in
our schooling those dietitians we were
taught some of these things and so it's
kind of what's on our mind is is this
something that is even safe so the first
one is microbial contamination there
have been some publications that talk
about you know hospitals that are using
blenderize to feeding and having a very
high amount of bacteria in their
formulas but a couple things I would
like to point out about the studies that
are published they were in hospitals
where the temperature is 80 to 90
degrees Fahrenheit and they do not have
air conditioning 98.6% of the blender
ice to feeding formulas actually had
unacceptable levels of contamination at the
the
time of preparation so you can imagine
bacteria did increase after being in the refrigerator
