A Blendable Feast
Advanced accredited practising dietitian, Lina Breik
The Australian medical sector has been slow to explore and embrace blended tube feeds as an option for enteral nutrition – but Melbourne-based dietician, Lina Breik, is working to change this. Here the founder of Tube Dietitian explains her ‘pro-choice’ approach to enteral nutrition and busts some common myths surrounding blended feeds.
Tell us a bit about who you are and the work that you do.
My name is Lina, and I am an accredited practising dietitian. Through working in several hospitals, for a decade now, I’ve learned that people want to be treated as humans, not as their condition or disease. People wanted to feel heard and that their choice of nutrition intervention is seriously taken into account. No one wants to feel like they are part of the ‘one size fits all’ equation that is sometimes applied in therapy and treatment. This is particularly true in nutrition; an individualised nutrition approach is our duty of care as dietitians.
After working for so many years in the hospital system, I began to appreciate that the future of healthcare is moving towards being in our homes where we are most comfortable. With that in mind, I started Tube Dietitian in March 2020. Tube Dietitian is an agile home-based nutrition service aiming to bridge the gap between hospital and home for people with feeding tubes.
Why is tube feeding a particular passion of yours, and when did blended feeds become a point of interest?
Approximately 7000 people across Australia and New Zealand are tube-fed. I began to think of ways to de-institutionalise tube feeding, take it out of the hospitals and into people’s home life. Unlike any other treatment such as chemotherapy or antibiotic therapy, tube feeding is a lifetime necessity for most people that end up with a tube. I wanted to think of a way to prevent their frequent hospital trips for nutrition reviews, bring back the human and social aspect of food, and support them in having a completely ‘normal’ family life even with a feeding tube.
As I started to properly listen to many patients of mine who are tube fed, I realised that food is truly a love language to them as they would express sadness towards never having a family dinner again. Food is our identity, our culture, a warm home-cooked meal by Mum or Grandma. That is when I got interested in homemade blended feeds.
Being science-trained, I started my research into the topic by looking into the scientific reports about blended food through feeding tubes. I found that in the UK, US, and Canada, homemade blended feeds seem to be accepted by their major scientific bodies such as the British Dietetic Association and the American Society of Parenteral and Enteral Nutrition.
Research is now showing that if done safely, with proper food hygiene practices, a high-quality blender, and nutritionally adequate recipes, homemade blended tube feed formulas may improve outcomes such as gastrointestinal problems for certain people.
I love how you advocate for choice in this area, rather than waging a war on formula. Can you tell me about your approach?
Yes, that is exactly right. You have nailed my approach with that statement! I by no means am ‘against’ commercial formula. Having worked, and still working, in many hospitals across Melbourne, I have witnessed firsthand the benefits commercial formula has had on critically ill patients in the intensive care unit, hospitalised cancer patients with a very low immunity, pre- and post-major gastrointestinal surgeries, patients on fluid restrictions, and/or patients needing continuous 24-hour pump feeding. This is not a matter of one – commercial formula or homemade blended tube feeds – being better than the other. Blended tube feeding is not for everyone, but neither is commercial formula.
My call to Australian health professionals to embrace homemade blended tube feeding is a call to support patient-centred care, patient choice, and a call to de-medicalise food for people with life-long feeding tubes, if they wish to do so. If the patient or primary carer wishes to trial homemade blended tube feeding – whether it be for an intolerance to commercial formula reason, or just simply for a social or cultural reason - we should be able to support, guide and help our patients to do it safely and in a nutritionally adequate manner.
It is our duty to research potential risks and benefits of this practice and be able to help our patients make informed decisions, rather than them seeking assistance from unreputable websites or self-proclaimed nutrition experts.
Why has the Australian medical sector been slow to accept blended feeds as a viable option for people who are tube fed, and how are you working to speed things up here?
Given only a small percentage of the Australian and New Zealand population is tube fed, there is not much health professional exposure to tube feeding and the options of what to put down the tube. With minimal exposure comes minimal acceptance. As such, those of us who are parents or health professionals that care for people who are tube fed have a big role in raising awareness and advocating for freedom of choice in this matter. The research is on our side – and so are major international nutrition bodies.
I am currently working with two nutrition bodies in Australia to change the wording used around homemade blended tube feeding to reflect the actual science. I am very pleased to say I have not been met with resistance from these organisations. It is just a matter of time now for us to publish the material we are working on. We are slowly catching up to other countries, but still have a long way to go.
In addition to the lack of awareness and information, I think a lot of the reasons parents and people are reluctant to try blended feeds are fear related. To dispel some of the stigma and misinformation that’s out there, can you bust some common myths for us?
Myth 1 – “Homemade blended food creates a higher risk of tube blockage.”
Typical reasons for tube blockages include:
infrequent water flushes
improper crushing of medications
slow feed rates
The first two can be easily prevented with careful regular water flushing, correct crushing of medications, and flushing between each medication. In terms of slow feed rates, this is a risk with homemade blended tube feed formulas - but can be prevented with a good quality-blender and adequate blending time to ensure particle sizes are as small as those in ketchup or a smoothie.
Myth 2 – “Homemade blended food creates a higher risk of infection from food contamination.”
If the following rules are followed, using homemade blended tube feed puts you at no higher risk than eating home-cooked food through your mouth:
proper hand hygiene
thorough washing of all equipment used to make the blends
usage of separate cutting boards for meats and vegetables
ensuring proper storage (i.e., refrigeration until used and between feedings)
discarding feed after 24 hours
hanging the feed for a maximum of two hours
A recently published 2020 study looked at bacterial contamination of homemade blended tube feed made in 50 people’s kitchens using a standard preparation procedure. They concluded: “88% of the samples met the US Food Code criteria for safe food consumption.” Milton D, et al. Nutr Clin Pract 2020.
Myth 3 – “Homemade blended food can never be nutritionally adequate.”
With a variety of high-quality blenders in the market, you can blend just about anything these days. You can reach full nutritional adequacy with homemade blended tube feeding as you can eating through your mouth. The same principles apply – lots of variety, lots of colour, fresh, wholesome plant-based food. For great examples of how easy it is to reach high protein, high nutritionally dense recipes, check out The Natural Tube Feeding experts recipe book.