Au Naturel

Dietitian Claire Kariya

Canada’s Claire Kariya is a self-professed, “tube-feeding obsessed” dietitian. A world-leading pioneer in the blenderized tube-feed space, she shares some of her wisdom for people who are curious and keen to get blending. 

Tell us a bit about who you are and the work that you do.

I’m a registered dietitian based in Vancouver, Canada. I work at a major hospital and I have a private tube feeding practice where I provide support to people who are interested in using blended food for tube feeding. I believe that everyone should have the option to have fresh food in their tube fed diet and I do my best to promote acceptance of this practice in the medical community. 

I conduct blenderised tube feeding research and have developed policies and guidelines that support the use of blended diets in hospitals and community settings. I also love to develop homemade tube feeding recipes that are highly nutritious, simple to make and taste delicious for people who want to share meals with their tube fed loved ones.  

What is one of your earliest memories of food?

I have vivid memories of eating wild blackberries right off the bushes when I was a kid. The warmth of the sun, the companionship of my family, and the fragrance and colour of the berries are what make that memory special, not just the delicious taste. I think this is a good example of how food can be experienced in many ways and tasting is part of the experience but not necessarily the whole experience. This is an important consideration when thinking about how to connect tube fed people with food, even if they can't eat.

When did you know that food - and the science behind it - was something you wanted to focus on professionally? 

I’ve always had a love of food and an interest in the science of digestion and nutrient absorption. In high school, I didn’t know that I could study nutrition in university or that nutrition was a career option. Luckily, while I was in university, majoring in kinesiology, I was required to take a class called ‘Nutrition 101’. I loved every minute of the class and realized that I would rather be studying nutrition than kinesiology. I switched into the nutrition program and went on to become a dietitian. I feel very fortunate to have found a career that I love.

Why is tube feeding, in particular, a passion of yours, and when did blended feeds become a point of interest?

In my job at Vancouver General Hospital, I regularly work with patients who require long-term tube feeding at home.  For at least the first five years of my career, I only recommended using formula for tube feeding. I honestly didn't know there were other options and I felt perfectly comfortable with formula and the security it offered my patients. Around this same time I was becoming deeply aware of the loss that my tube fed patients and their families experienced when they became unable to eat by mouth for a variety of medical reasons. 

I was working with adults at that time and had many conversations where my patients would express how sad they were that they would no longer be cooking, looking at recipes, grocery shopping or sharing meals with their loved ones. I felt that I had nothing to suggest that would help them have a more positive outlook or make up for this significant challenge that they faced. 

Everything changed after I met a tube fed man who had been making his own blended meals for tube feeding for over 20 years. His diet included a variety of foods and more often than not, he ate the same food as his wife, but his meals were blended up and put down his tube. 

I was inspired. This was a turning point in my career. I began to question why I was so limited in my practice and how I could ever have thought that a diet based only on tube feeding formula was acceptable for long term nutrition. I realised that this was the answer that I had lacked for so long. With blending, my patients didn’t have to give up on cooking and shopping and sharing meals with their loved ones. Sure, their food needs to be blended, but isn’t that a whole lot better than nothing? I certainly thought so and my new tube fed acquaintance assured me that this was the case.

So, I dove into blenderised tube feeding and read every article, blog, research paper and guideline on the topic. It was about 10 years ago now that I decided that going forward in my career, all my patients will be given a choice for their tube feeding: blended food, formula, or any combination of the two. Whatever my patients decide to use, I would support them. 

How did you manage to convince hospitals in Canada that it was okay for inpatients to have blends? And is this still a work in progress?

I think that this is still a work in progress as there are many hospitals across Canada and there are many different policies when it comes to blended food for tube feeding. I often hear about other Canadian hospitals taking major steps to support blending, but I think we still have a ways to go. Although I can't control what is done in other hospitals, I knew that I would do whatever it took to make sure that my hospital was supportive of blending.

For me, it comes down to the principles of patient-centred care – the patient, or their family/decision maker, should decide what kind of nutrition they recieve. We as healthcare practitioners should do everything we can to make sure that the nutrition care plan respects patients’ individual preferences and values. If they choose to have blended food for their tube feeding, we should support that choice as best we can.

My hospital had always taken this approach when it came to oral diets – for example, we can accommodate vegan requests and diets that align with various religious beliefs - but for some reason, we didn't offer any accommodations for tube fed people.

Ultimately, I think what convinced my hospital and, subsequently, the other hospitals in my region is our obligation to provide patient-centred care. Just because a person is tube fed, it shouldn't mean that they no longer have a choice as to what goes into their body for their nutrition. Also, I think that when the decision makers at the hospitals in my region really thought it through, they seemed to realise that it's just food, blended. It's not dangerous and it's not something we need to restrict. Simple as that.

For parents and people who are new to the tube feeding space and want to explore their options - where would you suggest they look? What resources do you recommend for your patients?

We definitely need more resources! I created Natural Tube Feeding because there were so few resources available for my patients who were interested in blending. Of course, I wholeheartedly recommend my recipe ebook and online course to anyone new to tube feeding. I also would encourage visiting the Oley Foundation website and getting into some of the tube feeding facebook groups so that you can connect with other tube-fed people or parents of tube-fed children. It's so important to know that you are not alone.

Claire’s top 5 tips for getting blends right

1. Usually it’s important to make blends that are calorie dense.

I like to define this as containing at least 1 calorie per mL. If this sounds complicated, don't worry. All it really means is that you want to make blends that have lots of calories (energy!) in a reasonable volume. So, when you are thinking about foods to blend together, make sure that you are picking foods that will make for a hearty blend. 

You can't go wrong with ingredients like cooked grains, root vegetables, avocado, eggs, tender meat or fish, beans, lentils, oils, nut butter and calorie-containing fluids like milk or milk alternatives. If you want, you could ask your healthcare team to provide calorie targets and you could use a nutrition app to see if your blends are high enough in calories.

2. Be thoughtful about the type and amount of fluids that you add into your blends.

It’s really important for people on tube feeds to stay hydrated, but you wouldn't want to use excessive fluids for blending. This is because you might be diluting the calorie density of your blends by adding too much liquid. Just add enough liquid to get the right consistency for tube feeding. Remember, you can always add more fluid if needed. 

I also suggest blending with fluids that contain calories and protein. This boosts the nutritional content of blends. So, think about using liquids such as milk or a plant-based milk, juices or even canned coconut milk as this will really help keep the calories in your blends up.

3. You'll want to include a variety of foods in your blends.

This way, you’ll make sure that each day all necessary nutrients are consumed in adequate amounts. Think about having a balance of carbohydrates, protein and fats. Generally it's a good idea to have a fruit or vegetable in each blend, and a source of protein. This will help ensure that the person you are blending for gets plenty of protein and enough vitamins and minerals. If you're not sure if your blends are balanced, show your recipes to your healthcare team and get their input.

4. It's really important to get the right consistency with your blends.

If you're using a pump for feeding or if you want to infuse your blended meals by gravity, you should be aiming for a ‘smoothie’ texture. In other words, you want your blends to be pourable and able to easily flow. If you are using a syringe for tube feeding, your blends can be thicker, up to a ‘ketchup’ consistency. You'll know if it's too thick because you will not be able to draw up an overly thick blend into your syringe.

5. Make blends that look good and smell good.

Blending is about more than calories! Try to include favourite foods and cultural foods. Experiment with ingredients and make colourful blends. Blending isn't a perfect science. You will learn from your mistakes. The most important thing is to make sure that nutrition goals are being met, so make sure you work with a great dietitian to help you with this.