The Gut Healer
Peadiatric gastroenterologist Usha Krishnan is passionate about tummies. She was one of the experts who developed the AuSPEN consensus statement for blenderised tube- feeds, so who better to ask how this diet is changing the enteral-feeding space.
Why are stomachs your chosen specialty?
As a paediatric gastroenterologist, the stomach is an integral part of my area of specialisation. But I’ve always been passionate about food, nutrition and children’s growth because it impacts not only on the gastrointestinal system, but overall wellbeing and quality of life – and not only of the child, but of their whole family.
What are your earliest memories of food and family?
I was born in India and Indian food is very diverse, colourful and tasty. My earliest memories are of my mum cooking different kinds of foods in the kitchen and me hanging on to her, following her around and trying to see what she was doing.
Why did blended feeds become an area of interest for you?
A significant proportion of the children that I look after have enteral feeding and although commercial formulas are nutritionally complete and help a child grow, I was increasingly hearing children – or their parents – saying they were having side-effects from the standard formulas.
Yes, they were putting on weight, but they might be complaining of tummy pain. They could have bloating, diarrhoea or constipation. They might be vomiting, gagging and retching. Do we really need children to be on something that is making them unwell in other ways, even though they might be putting on weight?
This is one area where innovation has been led by parents more than doctors. I started hearing about real blended food from parents and that stimulated me to read and learn more about it so I could help my patients. In the last two to three years, half of the parents I see are asking me about blended feeds.
My son was orally eating real food right up until his G-tube was put in – but we got sent home from hospital with a carton of commercial formula. Why is this happening?
It really shouldn’t be happening. One of the dietitians in our hospital did a study that found parents saying ‘we got more information from the internet than we did from our doctors and dietitians’. I know we should be helping you and supporting you.
And hopefully under the new consensus guidelines for the use of blenderised tube feeds which have come out from Australasian Society of Parenteral and Enteral Nutrition (AuSPEN), parents will feel empowered to tell the doctors and dietitians, ‘we want to do this’.
We are educating the dietitians, too. And as they are learning more about it, they’re feeling more comfortable
prescribing it. This is why we need more research into it – and that’s what we’re trying to do at AuSPEN. We’re trying to get more funding to do more research, because if doctors and dietitians understand more about why blends work, they’ll be more willing to support this diet.
What evidence does exist around the benefits of blended feeds?
We recently did a study where we compared a group of kids on blends to a group of kids on commercial formula and we found that both were equally nutritionally complete. But for the kids on blends, their gastrointestinal problems and quality of life was better, the microbiome [community of microorganisms living in the gut] was richer and more diverse and they had less inflammation in their bowels.
However, I should mention that we did find that they’d need more calories to maintain the same rate of growth, so blends weren’t for everyone. But we also discovered that you don’t necessarily need to be exclusively in one group or the other. Even a diet of 25 per cent blends was enough to reduce symptoms and still help maintain growth.
Is there progress being made in the commercial formula space for kids who are limited to this diet?
Absolutely. Everything’s about the microbiome and if you have a richer, more diverse microbiome, it’s better for your overall health. So they’re trying to add prebiotics and probiotics and reduce preservatives in the commercial formula space, too.
The team at AuSPEN published the blenderised tube-feeds consensus statement, what’s next?
We’re also trying to develop a web-based app for blenderised tube- feeds. The idea is that you tell the app what you’ve put in your blender and it tells you the exact nutritional information for your meal. I hope we’re able to get funding to develop this app – it could be a fantastic resource.
What advice do you have for families who are keen to try blends?
You need close supervision with a knowledgeable dietitian to be sure that your child is meeting nutritional requirements. Some studies have shown you need 120 to 150 per cent extra calories on a blended diet to maintain the same rate of weight gain that you would on a standard formula. So parents need to be willing to work creatively with their medical team and dietitian.
The pros and cons of a blenderised diet, according to Usha:
PROS
It might help with abdominal pain, nausea, vomiting, gagging, retching, bloating, wind, constipation and diarrhoea.
Children on this diet reportedly seem happier in themselves and feel more part of the family during meal times.
It might mean less infections, hospitalisations and admissions.
CONS
It’s not recommended for children on continuous feeds, those on jejunal feeds, or those under six months of age.
It might not suit people with very complex metabolic problems, multiple food allergies, or those who are immunosuppressed, because it’s not prepared in a sterile environment.
Very small tubes can get blocked. To avoid blockages you need to have a really good blender, which might be out of reach financially for some families.