July 8, 2012

To all those who travel here: Eric Aadhaar passed away, peacefully and with his beloved at his side, as the sun was rising on Sunday, July 8, 2012. His wisdom, humor, and compassion helped so many on our road to nourishing ourselves and the ones we love. His last post can be found on his personal blog, Entropy and Light: The Last Post.

For information on tube feeding and using real food through the tube, please scroll to the menu 
a bit lower down (on the right) for some comprehensive posts. 


March 22, 2012

It's here.

Finally, after all that, it's here.  I hit the 'go' button on publishing just 24 hours ago and only now am I remembering to mention this fact here.  Life goes on, with its other plans for us too, eh?

Anyway, for those that keep in touch by following my doings here, the book is properly real, and ready for you to read.  Typos and all.  I found a couple, and then though - fixing these means more days and days of not having it out there for people to use, and besides, it will never be perfect.  It sure isn't perfect, but I know myself well enough to know that I could spend forever polishing this doorknob and never opening the door ...

So I commend this book to you.  It is a fruit and labour of love, made possible only by the sharing, generous and supportive hordes I have encountered online and elsewhere along my own tubie journey, and that means you too.  So thank you.  All I hope is that it makes a positive difference to someone, somewhere.

You can visit the website, peek inside the book, and click through to the store to order your copy right here:

It was Leonardo da Vinci apparently who said that "Art is never finished, it is merely abandoned" and that surely applies to works like this one too.  It has to find its own way in the world now.  Please enjoy; and humbly, thank you.

March 14, 2012

Tubefeeding - a Brief History

Below is a sneak preview: an excerpt from Complete Tubefeeding (Everything you need to know about tubefeeding, tube nutrition and blended diets) , due to be published any day now.

1. A brief history of tube feeding
(actually it's a longer history than you might imagine)

The need to avoid prolonged starvation in patients is well recognized.”

(from the introduction to the American Gastroenterological Association's official recommendations on the use of enteral nutrition.)

These days when we get a g-tube or other sort of enteral feeding device placed, we go to a modern shiny hospital with highly-trained staff, expensive hi-tech equipment and machines that go 'Bing!' Most tubes are placed in a sterile operating theatre with a surgeon and an anesthetist, maybe some radiological equipment, and all sorts of brilliant tools. The devices themselves are made of state-of-the-art materials; high grade flexible silicon and specialized plastics, and often have quite the sci-fi look about them. Then you will be introduced to the truly amazing advances in synthetic nutritional products – they come in a bewildering array of different types and brands for different patient profiles and needs and yes, they really are a product of the space age. So we tend to think that the miracle of tube feeding is a pretty recent development. Well, yes and no.

In fact, it seems using tubes for feeding patients goes back at least 3500 years to ancient Greek and Egyptian civilizations. Papyrus evidence suggests that Egyptian physicians used reeds and animal bladders to rectally feed patients things like wine, milk, whey, broth and so on to treat a range of complaints. Rectal feeding would remain the artificial feeding method of choice for many thousands of years because of the difficulties in accessing the upper GI tract without also killing the patient. Some things in medicine have hardly changed at all, as not killing the patient remains important to this day.

There are some reports of tube feeding in the 12th century but the acknowledged Western pioneer was a fellow called Capivacceus who in 1598 used a hollow tube with a bladder attached to one end, filled with some form of nutrient solution, down as far as a patient's esophagus. The beautifully named Aquapendente used a form of nasopharyngeal tube in 1617 – the forerunner of our NG tubes, but only going as far as the pharynx. A guy (they're all guys I'm fairly sure) called Von Helmont devised a flexible leather tube for feeding into the top of the esophagus in 1646, which must have been a pretty good improvement in patient comfort over things like hollow whalebone. Then in about 1710 it was suggested that such tubing might be used to reach all the way to the stomach.

For the rest of the 18th and the 19th centuries gastrointestinal feeding was practised here and there but I suppose due to the discomforts and difficulties of keeping a tube down someone's throat - or whatever other reasons - rectal feeding was a more widespread and accepted practice. Some of the oro- and naso-feeding contraptions were quite sophisticated, for example in 1790 a physician called Hunter was doing oro-gastric feeding using a whale bone covered in eel skin attached to a bladder pump to feed his nutrient solutions. He is reported as using mixtures of jellies, beaten eggs, sugar, milk and wine. Anyone who's had a naso-gastric (NG) tube as I have will tell you it's a pretty awful feeling thing, even worse I would imagine back then, using the sorts of materials available before high-tech plastics and silicone. But imagine an oro-gastric tube! This probably explains why it seems NG tubes increased in relative popularity for gastrointestinal feedings as time went on. These tubes still most often only extended down as far as the fauces (the narrow part past the back of the mouth towards the pharynx) and in the 1870 mixtures such as thick custard and mashed mutton were forced through these tubes, or combinations of warm milk, beef broth, eggs, and medicines appropriate to the symptoms of the patient.

These sorts of feedings weren't just for patients who couldn't eat, mind you: according to physicians such as Coulton naso-pharyngeal feeding was also inflicted upon 'fasting girls and spoilt children who, when ill, refuse food'. In addition to tubes, devices that looked a bit like a teapot with a very long spout were made to force-feed patients in mental institutions mixtures of milk, egg, beef tea and wine thickened with arrowroot.

When US President James Garfield was shot in 1881 he was kept alive a further 79 days by being rectally fed a blend of beef broth and whisky.

BONUS History Trivia: Alexander Graham Bell also devised a very early sort of metal detector to attempt to find the bullet inside the President, but it failed to work – it was reading the bedsprings instead, and as metal bed frames were very rare then, no-one at the time could work out why the device malfunctioned. PLUS: One of the doctors trying to save the President had the given name of 'Doctor”: Dr Doctor Willard Bliss.

Rectal feeding does (thankfully) seem finally to have gone out of fashion although I am told that some medical students these days, upon learning of things like James Garfield's ordeals discover all over again that colonic absorption is a very fast way to get drunk. Apparently. Don't try it though, OK? Even if you are in college.

But gastrostomy – inserting a tube through the skin directly into the stomach – was not seriously suggested until 1837, and as far as I can ascertain, not attempted until 1845. Early attempts were apparently 'associated with many complications' (we can use our imaginations I think) so naso-gastric feeding remained the way to go for a while yet.

Now around about 1910, two things were notably happening at roughly the same time. A man called Einhorn was experimenting with nasally-inserted feeding tubes going all the way into the jejunem (what we would call now an NJ tube), that is, all the way past the stomach and into a part of the upper intestines. Elsewhere, research was going on with feeding dogs and trying to maintain a nitrogen balance (essential for healthy survival) by using solutions of hydrolysates. They did not experiment on humans as at this time hydrolysates were thought to be at least indigestible and possibly poisonous to humans. This research led in turn to better understandings in using predigested proteins and the role and use of amino acids, which would in turn help pave the way for modern synthetic enteral formulas. In the 1930s some doctors were starting to pioneer the use of hydrolysate-based formulas (now for humans) in NJ feeding for those whose stomachs were compromised in one way or another. These mixtures used things like a casein hydrolysate; essentially skim milk treated and fortified with acid, pepsin, salt, bicarb soda, dextrose and various vitamins. Even today this is a recognizable outline of the ingredients on the side of some cans of commercial formula.

One of the big issues with percutaneous gastrostomies – sticking a tube through the skin – was the problem of infection. Until the 1940s there were no really effective antibiotics so there was a bit of a disincentive to do a gastrostomy when an NG tube, although a slightly horrible experience for the patient, could do the job. But with the advent of modern antibiotics came an explosion in the sorts of surgeries that would be attempted, and would eventually become commonplace. At around this time too, some doctors began thinking that those experiments with more broken-down formulas for jejunal feeding might be applicable to gastric feeding scenarios as well … and now we can see the modern age rushing in upon us. Interestingly, much of the push to develop very broken-down formulas came about in attempts to meet the needs of patients whose GI systems had nearly or totally shut down – the idea was to feed them more than just glucose intravenously – so the early 20th century also saw the start of the development of central-line IV feeding (where the patient is fed not into the GI tract but directly, intravenously into the blood stream), called Parenteral Feeding.

Fairly quickly, these broken-down, synthesized formulas for enteral feeding became the norm; for a short while at least. It was quite an exciting time for the pioneers, who even went so far as to experiment with feeding patients into the jejunem during surgery. In 1949 polyethylene tubing was first used, and the first enteral feeding pump was developed. But problems of patient tolerance of these broken-down feeds seemed to be commonly arising. In an effort to address this, a sort of return to first principles took place: Hospital kitchens were asked to mimic a normal diet by finely pureeing and liquefying a blend of regular cooked foods, and naturally enough they were generally well-tolerated. The down sides in the hospital environments then though were cost – it was labour-intensive to prepare such foods, and (perhaps ironically) a hospital environment proved a difficult place to keep such foods free of contamination, as compared to sterile synthesized formulas.

In the 1960s, advances in the understanding of the role of amino acids led to further studies designed to see if new formulas could be devised to support patients without the side-effects those early attempts produced. This was supported hugely by the space program, with NASA getting very excited. They could see the great potential in an astronaut 'food' that was concentrated and gave a low fecal residue. These 'elemental diets' had many advantages for the nascent space flight program, in that they stored and transported well, had a very high nutrient density (so were very light), were very soluble so reconstituted easily, maintained an adequate nitrogen balance, and were easily tweaked and adjusted to meet an individual's specific metabolic needs better. But this stuff tasted so bad that the astronauts just refused to eat it. Even today, astronauts eat a largely natural diet, to the extent of taking fresh fruit and tasty baked brownies up with them. Tortillas make awesome edible, low-crumbing zero-gravity frisbees also.

Of course, patients taking their nutrition via tube do not really have a problem with how the solution tastes, and as more and more advances were made in materials for tubes, tube placement surgery and feeding formulas, the formulas derived from the NASA-led research became the standard go-to for tube feeding nutrition. But there was also a sort of medical research arms-race going on, with rapid advances in Parenteral Nutrition. For a while TPN (Total Parenteral Nutrition) was the one attracting all the attention, but quietly research continued in the roles of amino acids and other food constituents, in understanding digestion, absorption and gut physiology. Advances in the development of enteral feeding formulations, tube technology, and the demonstrated lower incidence of complications, lower cost and ease of access eventually moved enteral feeding to the forefront, where it remains the first choice option today.

Something else was going on in the 60's and 70's that related to tube feeding also – far fewer people were dying. Partly this was the result of a slow cultural change that had been gathering pace over the century – we seemed to become a lot less comfortable with allowing death to happen if it was at all avoidable, regardless of circumstances, in much of Western civilization – but a very large factor was technological. The miracles of antibiotics, amazing new drugs, advanced diagnostic and surgical techniques all combined to allow us to save lives that we never before would have been able to save. Serious accidents and injuries that once killed routinely no longer do. Life-limiting illnesses are still on the rise but with advances in treatment and diagnostics patients are tending to live longer. This modern phenomenon is especially pronounced at either end of the age spectrum, with the very young – the very prematurely born even – and the much older citizen.

Of course, saving all these lives means many more people living with serious impairments, a very common such impairment being the inability to eat. Since the last few decades of the 20th century, we've seen an explosion in the number of feeding tubes placed right across the world, most pronounced in countries like the USA. Actual numbers are hard to come by. According to an article published in 2005, there were around 344,000 people using a feeding tube at home in the USA, and the article quoted a 1995 study suggesting that 120,000 patients in long-term care were using feeding tubes also. One thing we do know is that tube placements have continued to grow faster than the population, so it would be reasonable to think there might be half a million to a million people using feeding tubes in the USA alone right now.

To go along with the boom in numbers of tube-fed patients, we now have commercially available enteral formulas in hundreds of different variations; many are very similar, just made by different manufacturers and to different calorie densities, but there are others designed with specific diseases and patient needs in mind. Most recently though, there has been an increasing uptake, driven in the main by parents and carers of tube-fed children and by adult patients themselves, in returning to a more natural food-based diet, often referred to as a blenderized, blended, or pureed-for-gastrostomy diet. It's almost as if we are somehow coming full circle.


February 19, 2012

Herbs and spices for digestive support

(Below is an extract from my soon-to-be-published book on all things tubefeeding-related, since so many people are asking about herbs and spices lately)

Outside of the world of naturopaths, herbalists and other natural health practitioners, there are a great many everyday culinary herbs and spices that we have known for millenia assist digestion and can help to resolve issues faced by tubies. Such foodstuffs have been used as medicine in various cultures since well before the dawn of written history, and we can take much from both the traditional wisdom and what modern science has discovered about their benefits and uses. Also, they can make a blend smell and taste that much more pleasant.

Herbs and spices are, and are not, like modern medicines. Most modern medicines in fact trace their development back to plant materials, aspirin derived from the bark of a willow tree being perhaps the most famous example. Herbs and spices can be very complex in their actions, but may be used to target specific complaints too, in the same way modern drugs are. Many however are simply said to be 'supporting' digestion. Some are said to 'regulate' digestion. These descriptors might mean a herb has opposite effects on a different person or on the same person at different times depending on what the body requires to move back to its best possible state of health: for example, promoting looser or firmer stools, depending on what is going on at the time. So 'prescribing' is not the best way to think about using herbs, focussing instead on using a wider selection to promote overall wellbeing and digestive health.

Which to use, how much, how and when? There can be no one good answer, but tips are given for each below. Think of it this way – use the herbs and spices as you would in cooking: go for the same pleasing taste and aroma concentrations. It is no accident that coconut and curry spices go so well together; each component supports the digestion of the other. The aromatic sweetness of cardamom in a yoghurt lassi drink can eliminate the mucus-thickening effects of the dairy. Those classic Italian herbs like basil, oregano, and so forth are all perfect to stimulate digestion of their typical partners in pasta, olive oil, tomatoes and so on. The culinary traditions are our very best guide to combining herbs and spices with foods and blends, but don't be afraid to experiment! Keep in mind that herbs and spices are string-tasting and strong-smelling because they contain very powerful compounds, and you don't want to overdo it. Again, the kitchen traditions are your guide. Start out with ordinary 'recipe' amounts, and if you're wanting to increase the dosage for specific effect, do so slowly and keep a weather eye on any potential adverse reaction. And give your herbs and spices a break from time to time. As with foods, the very same thing over and over is not ideal for us, and taking a break acts to refresh our response to the medicinal and nutritive effects.

Do please keep in mind this is a general guide only; I am not offering medical advice. In fact in most countries it is not permissible by law to make any specific health claims about herbs, spices or foods. If you can, consider seeking out a good herbalist, naturopath or trusted professional to help guide you along the way with more specific advice.

Sometimes called aniseed, and not to be confused with star anise (something different entirely), anise is related to dill and fennel. The seeds have a sweet rich licorice taste and aroma and help to digest rich foods, promoting good gastric motility and lessening bloating, cramping and flatulence. It regulates digestion, making it useful for both diarrhea and constipation. You can blend the seeds or make a tea and use that in blends or (cooled) on its own.

As well as having a mild calming and soothing effect on the mood and mind, basil is the natural accompaniment to tomatoes; it may aid in their digestion and absorption. Also helpful for stimulating the appetite, used for promoting gastric motility and relieving nausea. Use the fresh or dried leaf.

Black Pepper
Yes, common black peppercorns like you'll find in pretty much every kitchen in the developed world is a wonderful appetite and digestive stimulant; specifically it stimulates secretion of pancreatic enzymes. It also helps with constipation and flatulence and can help improve circulation. You can just toss a few peppercorns into the blender or grind them fresh from your pepper mill.

Caraway seeds are excellent for easing gas bloating and flatulence, can assist with colic symptoms and may aid in the prevention of reflux. The fresh leaves can be used also, directly in blends, as with the seeds. Caraway has been said to promote milk production in nursing mothers and assist with symptoms of bronchitis as well. It is ideal that caraway seeds be heated prior to ingestion, so either toss them in with cooking food (the perfect accompaniment to pumpkin) or give them a very quick dry-roast on a pan or skillet before grinding them. Uncooked caraway seeds may escape the blender blades and are just the perfect size to lodge sideways in a button valve, so consider grinding your dry-roasted seeds separately first.

Cardamom is a fantastic digestive tonic, aiding gas, bloating, and gastric motility, and can relieve stomach cramps. It can counteract the thickening of mucus secretions often associated with dairy products, and has been shown to have powerful anti-ulcer properties. Use the seeds freshly ground if possible, but powdered is fine and very easy to use too.

Cayenne pepper
This is a powerful digestive and circulatory stimulant, and definitely take care when using with children or those with very sensitive systems. It is used to treat indigestion, and unlike the advice generally given about avoiding spicy foods it may be that a small amount of cayenne actually improves acid reflux.

Soothes digestive upsets and provides relief from nausea; best used as a tea, you can use chamomile tea as a thinning liquid for your blends or bolus it (cooled) on its own.

A wonderfully warming spice, cinnamon stimulates digestion at all levels, gently encouraging bowel movements but also acting to alleviate diarrhea. This seems to be the spice that makes for the best-smelling vomit as well strangely enough, with a little bit making any such unfortunate eruptions rather less unpleasant to deal with. The bark of a tree, you can throw the 'quills' it comes in straight in the blender or use the ready-powdered form. Great with fruity blends especially I find.

The fresh leaves are a good stomach tonic, and the ground seeds also stimulate digestion and can help alleviate diarrhea. Coriander seeds have been shown to have some anti-bacterial and anti-fungal effects (as well as smelling and tasting divine) so may be useful that way too. These seeds blend just fine.

The fresh or dried tips and also the seeds of dill are classic pairings for egg dishes and shellfish. It helps soothe digestive upsets, especially colicky gas and flatulence.

Fresh fennel leaves can act as both an appetite stimulant but also then promote a feeling of fullness, very helpful for those trying to lose weight or who suffer from hunger pangs. It lessens gas, cramping and flatulence, Can assist with nausea and also insomnia. The seeds or fresh leaves can be blended easily or a tea made from the seeds.

Fresh or dried ginger is a very useful digestive herb, helping to speed digestion along but also calming the stomach, soothing nauseas and acting to reduce or prevent gas, bloating, cramping and flatulence. The fresh root has more active compounds but there is some evidence that dried powdered ginger may be more gentle in its effects. It can be added to blends or made into a tea. A tea with ginger, cayenne, lemon, honey and garlic is an excellent tonic for colds and flus.

There are hundreds of member of the mint family, and all the culinary mints can assist with digestion, easing gas especially that associated with consuming beans. It also has an anti-inflammatory action. Add the fresh or dried leaves to blends.

Humble parsley, the ubiquitous garnish herb, stimulates appetite and may also help with the assimilation of nutrients. It is very high in iron and Vit C as well. Use freely fresh or dried in blends.

As well as being good for coughs, thyme stimulates production of gastric secretions and mucus, especially useful for irritated stomachs. It has antibacterial and antifungal properties, yet also acts to support a healthy intestinal flora.

The fresh or dried, powdered vibrant yellow root calms the digestive system and stimulates production of bile and digestive enzymes. It has antiseptic properties, and reduces intestinal gas and bloating, especially that associated with beans and legumes. Use the fresh root or powder in cooking or straight in the blend but take care – it can stain a nice happy yellow colour.

This really only scrapes the surface of the herbs and spices you might find in your kitchen already. Those who make their own curry powders will recognise that several of these are key ingredients in many curries, and indeed most curry mixes will assist with digestion also. Herbs and spices are best as fresh as possible, or in the case of powdered spices, freshly ground if you can. Buying in small quantities from a source with a high turnover of stock is ideal if you are able.


January 11, 2012

Bloody Goldfish on toast for supper again.

My dad was an Antarctic adventurer.  Unsure quite what to do in life, not yet ready to settle into teaching after his University studies in maths and a diploma in education, and following a career so far speckled with odd and interesting jobs he answered an ad in the paper seeking people to join an Antarctic Expedition crew for a year.  He did a crash course in meteorology, Antarctic survival stuff, and sailed for the icebound continent in 1956 or thereabouts as a 'weather guesser'.  They were primitive times back then, he was only the second crew to man their station at Davis, so they inherited a one-room hut and took with them the makings of the rest of the station on board the ship, which they had to build as soon as they got there.  Small crew, all men, with very limited contact via dodgy radio with the outside world for a year or more.

And of course they had to take all their own food with them.  Though there could also be trying moments when one gets (for example) stuck in a blizzard that lasts 14 days with only a week's supply of food (which is how much you take for a 2-day field trip in Antarctica, just in case).  Certain unpalatable truths about seal meat, dog flesh, and so on are learned too.

Huskies (the dogs they used to use for getting around back then) can live off a diet very high in seal meat, so long as you don't then eat the dogs, especially the dog's livers.  Certain vitamins get concentrated to toxic levels.  Fun But Obvious Fact - dead seal freezes, so the best way to cut it up is like a log; in rounds, with a chainsaw.  Glad you know that now? :-) This is the Antarctic Leopard seal. They are notoriously unfriendly.  Do not try to pat one.

Luckily, my father's expedition had a Frenchman in the crew who just happened to be an excellent cook.  He didn't just bake bread, he plaited loaves specially, and gave them some actual variety and joy when it was his turn to cook.  But of course, nearly everything that went down with them was tinned.  And you can imagine the boredom of the same tinned diet over and over and over for months and interminable months in a small building with 6 or 7 others.

Which brings me to the Bloody Goldfish.  That's the typically Aussie name they gave the detested Sardines in Tomato Sauce - detested not for any reason other than because there were so bloody many of the bloody little things, meaning they were a most frequent dietary item.

I've never eaten a tinned sardine in my life, and we certainly never had them in our house when I was growing up.  Dad would make shuddery comic-disgust faces whenever someone said the word 'sardine' and mutter "uuurrgh Bloody Goldfish" under his breath.

One erstwhile tubie momma (her boy has successfully weaned and eats like a champ now) had a standard super-food blend she'd make involving sardines, avocado and olive oil.  Yes, heavy on the fats but they're all good fats and when you have a look at the breakdown of nutrients it's an amazingly full and power-packed blend.  She'd add other stuff around this but this was a very regular blend backbone.

Recently, in the course of research for my book and through life in general I've been prompted to think about including some more animal-sourced foods in my diet.  I am typically a lacto-vegetarian blender you see, relying mainly on legumes, nuts, seeds and dairy for my proteins.  Very very rarely I'd blend egg if it had been baked in something or if we had egg leftover from a meal for guests.  Just easier when you have a vegetarian household - no meat-handling issues in the fridge or sink etc.  Still, Meeta's fine with my consuming whatever as long as I'm 'clean' about it and eventually I decided I would.  I'd start with these little oily fish that are so calorie-dense and so good for you.

I've spoken of it before, the advantage I have of being my own blender, and able to communicate; I can 'listen' to my own body, and in fact removing the distractions of taste and smell and all that joyous stuff around eating has made me even more keenly aware of how food feels and how my body responds to it.  And it was saying it wanted sardines.  Also, maybe some emu, kangaroo, and some bone broth-type stuff, probably from a cow.  Emu is my favourite meat of all; if you're a carnivore and you've never tried it, seriously do yourself a favour.

Of course, I wouldn't buy the Bloody Goldfish.  Apart from anything, it's hard enough finding good sustainably-fished sardines from local waters let alone ones with organic extras so good ol' spring water it was for my little tinned guys.  I have eaten sardines before, but fresh luscious ones caught earlier that day, not the tinned ones, as I mentioned.  They do go with tomato really well.  And it's tomato season in my garden right now:  here's what I blended:

Tins sardines in springwater x 2
Light rye sourdough bread w caraway seeds (org, baked by me that morning),  large chunk.
Lettuce, various types, from the garden
Tomatoes, cherry pear variety, from the garden
Capsicum (bell pepper) from the garden
Basil and marjoram, from the garden
Garlic cloves, locally grown
Organic tomato paste
EVOO, organic, from just down the road.

I had an avocado in the fridge but it turned out to be what lots of chefs I know call a 'hand grenade' so its grey mooshiness is now happily feeding worms.  I added a splash more oil because of this.

As food, I imagine having roasted the little tomatoes and peppers in some oil, and mushed them into the sardines on to fresh hot toasted crusty rye sourdough, with the herbs roughly chopped through and some salad leaves.  Mm.

I didn't weigh or measure, and got 2 litres of pretty thick but rich and smooth not-too-fishy-smelling ochre-coloured blend that I had roughly estimate at about 35-40 cal/oz.  Not too fatty, and a good spread of nice nutrients. Very 'crunchy' in the green/locavore/organic/hippy sense too if you're not hung up on the whole animal death thing.  And I have to say, a couple of hours after a feed, it feels really very good.

I plan to honour the demise of a few more animals by consuming their flesh thoughtfully and respectfully in as friendly a way to them and our planet as I can in the near future.  I'll keep you all appraised of any interesting developments. :-)

This is Davis station in the summer after my dad lived there.  The Vestfold Hills area of Antarctica remains relatively ice-free, especially in summer.  Nice climate too.  On mid-summer days the temperature may even get up to freezing point - t-shirt weather.  40 below was more typical though.


January 5, 2012

Mini (ONE) Step At A Time


This might mark a little watershed moment.  Although I'll admit to a slight dose of skepticism, just for now.  What has happened to make this watershed?  In brief, that a large corporate market player has stepped out from under the wing of pharmaceutical company protectionism and made a bold statement in support of food.

The skeptic asks me how long this might remain the case; whether some backpedalling may occur, and wonders at exactly the motivations, but no matter - for now, this is a Good Thing.

For those outside the little loop world of we tubies, enteral feeding devices come in two types - tubes and 'buttons'.  Most people, especially for children with tubes, opt for buttons, as they don't dangle about the place.  Most buttons are retained by internal water-filled balloons which make them simple to replace at home.  The 'button' has now effectively lionized the market.  The market is controlled by just two companies, with different varieties of their own products.

AMT, makers of the rather popular MiniONE button amongst other enteral devices and one of the two main players has just said this on their website page, under the heading section of Are You New To Enteral Feeding?:

"Wherever possible, real food is still the best thing for feeding people, whether they eat the regular way or through a tube."

This is a BIG call.  I have seen device manufacturers' literature saying that their devices are suitable for enteral formula and blenderized foods before, but never have I seen a corporation, one of the Big Medicine Corps, effectively say to the entire marketplace that food is better than formula if you can do it.  Can they get away with it for long, do you think, before someone at Big Pharma takes countermeasures?  

Of course, such countermeasures have long been in place against using food for tube feeding, ever since a reliable and sanitary product that could be shown on paper to provide a spectrum of nutrients suitable for theoretical human life that could be profitably sold was created.  It's called education.  Doctors and dietitians are busy, time-poor people, who often feel under-rewarded for the long and arduous hours they put in at humanity's service, and despite the canniness of many of them, they are vulnerable to slick messaging from the only people with deep enough pockets to provide most of their free, ongoing postgraduate education - the Pharma Corps.  I do not mean to completely belittle the value of such education - of course they need to keep up with developments and changes in science and best practice, and for the most part it is pharmaceutical company funding that drives the research and innovation.  They also put on very nice dinners (I should know, I've hosted enough of them).  

But food has no such champion.  Big Food certainly throws it weight around the mass market and leans heavily on governments around the world to get their bidding done, but the tubie market is too small.  But we're a VERY lucrative market for Big Pharma.  Also, for AMT and their competition.  Naturally, they want the goodwill of the fastest-growing market segment of the fast-growing tubie market.

Still, I congratulate those at AMT with the stones to make this call, even if for now it is just on one part of their website.  They kindly link directly to our sister site (where many of this bog's posts are reproduced and I am a co-administrator also), blenderizeddiet.net.  

Here's to the notion that this might be a key moment in the opening up of the thinking of the medicalized world of tube feeding.  That one day, we might see food on an equally-respected footing with enteral formulae as an option, as well-supported and accepted if not more so, in the medico-industrial complex.

It's not too much to hope for, is it?

EDIT UPDATE: I have just been informed by AMT's marketing manager Lisa Szpak that they have amended their website, saying that "the wording on the website is what you requested to best describe blenderizeddiet.net".  I understand that Beverly Hanset-Burch, our co-admin there, previously provided them with some information they could use.  Lisa went on to say "AMT does not currently have a position regarding real food versus formula.  Nor are we aware of any movement by pharmaceutical companies or device manufacturers regarding real food versus formula.  I apologize for any confusion this may have caused.  We have modified our website to more accurately represent the subject matter of your website."

Sadly, my fears proved founded then.  They have bailed on us regards any endorsement.


December 21, 2011

'Crunchy' blends can go smoothly too.....

For those unaware, recent times have seen the second-top definition of the word 'crunchy' in most dictionaries as "politically and environmentally liberal" (as in "music that incorporates whalesong sounds pretty crunchy to me"). Or this, more fully from urbandictionary.com - "Used to describe persons who have adjusted or altered their lifestyle for environmental reasons. Crunchy persons tend to be politically strongly left-leaning and may be additionally but not exclusively categorized as vegetarians, vegans, eco-tarians, conservationists, environmentalists, neo-hippies, tree huggers, nature enthusiasts, etc. "  Apparently the etymology of it goes back to a commonly-used phrase in certain circles in the US - shortened from "crunchy granola people".

Lately I've copped a bit of (mostly good-natured) flak about the crunchy nature of most of my blends.  Fair call, and being Australian I am all for the sort of well-meaning stirring we often charmingly refer to as "shit-giving", since being vile to each other and heaping insult and deprecation on our close friends and loved ones proved a valid means of overcoming the torpid emotional stifling and suppression that came with the English part of our foundation.  We're not quite so comfortable with declarations of love as we are with personal insult.  So when you meet an Australian, and when they first call you a bad word, then you know they like you a lot and have accepted you as a friend - just so as you know, OK?  You silly bastard.

So anyway, yes, my take on things nutritional is unapologetically a bit on the crunchy side.  Like a hippie into top-fuel drag racing though, I also wholeheartedly approve of Nigella Lawson's ridiculously consumption-oriented antics in the kitchen in that her message at heart is about joy and love and the shortness of life.  She just expresses it differently from the way I do, is all.

An oft-commented-upon phenomenon when people begin a blended Tube Food journey is the dawning of awareness of food in a whole new way - whether we are blending for ourselves or someone in our care.  In fact, it especially applies to parents of small children.  What happens, by simple virtue of putting stuff into a see-through container and turning it effectively into stomach contents minus the lumps and digestive juices is that we see and smell what a whole meal is really like, down at 'gut' level.  Of course there's the informational approach as well to do our heads in; just in case the blender wasn't illustrative enough.  We read the ingredients on a can of formula, are perhaps a little horrified as we fully understand what it is humans are being asked to subsist on, solely, for the foreseeable future. Then when we go to replace that with a 'regular' store-bought sort of pre-packaged meal (such as we'd happily eat at home), reading the ingredients and scrutinizing the caloric values and nutritional breakdowns gives us another pause for thought. So many unnatural chemicals, so much fat, sugar, salt, so highly denatured and processed...........but it's still OK because it isn't formula; that still makes it OK as Real Food doesn't it?

That, friends, is for each one of us to decide.

My last post here was all about choosing better over best, and why it's a sensible approach.  I stand by it, as I stand by Nigella's genuine quest to enhance our enjoyment of all things foody.  But my journey, and that of many tubies and tubie carers, takes a different path; one more akin to entering the food, to accepting the axiom "you are what you eat" as more than just a throwaway line. This runs the risk of being seen as very crunchy indeed.

We tubies tend to be an unwell lot on average, it must be said.  I mean there are reasons we have tubes, it's not a lifestyle choice for most of us.  And when you take the connection between nourishment and wellness,  then it's hard to turn away from.  The burden of such knowledge, that you can almost without any doubt make a huge difference on your spectrum of ill-health to good-health just by changing your diet, is a heavy one, unless acted upon with some grace.  Admitting that our average diet is frankly an unsustainable horror and abomination to the planet and our health is hard.  It means changing our ways.  Facing up to things.  Admitting we have been conned, perhaps.

But all too easily, steps on the road to this awareness can feel just so relentlessly negative, and this demotivates many of us. Such negativity is often cited as a reason to shy away from falling in with the crunchy brethren and settling for more of the 'regular' normative diet of Homo Microwavicus.  I'm referring to the set of discoveries that those seeking information about food and health make very early on - that pretty much everything that you used to think of as 'food' gives you cancer, heart disease, diabetes, makes you obese, is addictive, messes with your mood and stunts your intelligence.  Etcetera.  It can seem like it's an all-or-nothing venture, either you become a sandal-wearing vegan self-sufficient organic solar power producer and join the ranks of the annoyingly self righteous or you just shy back from the enormity of the whole modern diet catastrophe and settle down to a big dish of nice consoling 'low-fat' chocolate and bacon icecream.  I know many people are simply put off by the mention of a whole grain, an organic vegetable, a mung bean.  And anyway, isn't it all like really hard work?

This last myth is the one I want to bust today.  That using good whole foods is difficult, that *cooking* in itself is hard, takes loads of time, and is expensive.  Baloney.

Double baloney if you have a good blender at your disposal.  Many folks new to the idea of a blenderized diet start from the premise that food will need to be treated in very certain and specific ways to be safely used in a tube.  Not so; in fact, quite the contrary.  I found that getting to know my Vitamix was one of the most liberating things I'd ever experienced with food.  Simply put - I can blend anything.  Paradoxically, this makes it easy to just throw in some Carnation Instant Breakfast, skim milk powder, Cheerios and perhaps a Twinkie and be done with it.  Just as easy is opening a can of formula, and the formula would be arguably better for you too.  But the real possibilities such a blender opens up are awesome - if you're cooking a healthy meal for the family then that can go right in the blender too.  How simple is that?  Any food you can think of to eat in the whole world - you can blend it.

Maybe you've done a bit of reading, and been inspired to go down the local market and buy some bulk whole grains, or legumes.  Maybe you live in a food desert and have to travel to get such things, so you stock up - all good.  You've discovered that frozen vegetables are not only often better quality than 'fresh' from the supermarket but way cheaper too.  Perhaps you've gotten word around with friends and decided that if you all pool together you can buy half a grass-fed organic cow, have it butchered, divided between you and put up in the freezer.  These things all make crunchy so much cheaper than the cheapest junk food it's beyond belief.  Rice and beans or any grains, chosen well, with a little bit of some good fats, some vegetables, maybe some animal parts or secretions, that's the foundations we're talking about.  And if you only look at the adventure from a tube Food perspective, then the whole area of cooking becomes suddenly ten times easier.  Why?  Because it just doesn't matter how it looks, what it tastes like, or whether you cooked it totally 'right'.  It's pretty much impossible to fail.

Crunchy really is just as quick as the alternative, but there's a catch - crunchy usually means waiting.  Rice takes a little while to cook.  Soaking beans is a really good idea, so you'll find yourself spending a whole 120 seconds (that's two minutes) getting out a bowl and some water the night before.  Job's already half done then, you see.  Inventions like rice cookers and slow cookers make it so amazingly simple and easy to prepare too.  Grains, beans, vegetables, meats, whatever - in the crock.  Set.  Come back 3 or 4 hours later and blend.  That was 15 minutes of your life, just spread over a morning or afternoon.  And the rewards?  You've spent less cash (if you've shopped or grown well and wisely), gotten tastier food, better nutrition, a sense of providing and accomplishment, and taken less time than wrangling a bunch of cans/jars/plastic packets, microwaves and other gear, plus you've been quite a bit kinder to the environment.   But there are TWO extra benefits that come from this, neither of which seem obvious in the face of the other.

One, every step you make towards a more naturalistic and 'whole' crunchy approach to food makes every other step that more inviting, that bit more inspiring and easier, as you discover new sensations and flavours, and gain confidence.  Of course, noticing great health improvements can be pretty motivating as well.  But number two, opposite to this and just as important, you'll probably come to care far less about the occasional 'bad' food choice episode.  You'll stop feeling such guilt at consuming a processed convenience or indulgent luxury food here and there.  You'll recognize you're making a certain trade-off between your momentary sense of wellbeing (it was late, convenient, and it's a tasty treat for the family etc) and your desire to feed your tube or your tubie as healthfully as possible.  Why?  Because you'll have the satisfaction of knowing that all that other crunchy stuff you're doing is making up for such stuff.  You can have your Nigella Lawson moments and buy the extravagantly enriched dark chocolate nibblies without overly worrying about the transnational corporation's probable use of child labour or the empty fat-forming calories because you'll have realised by now it's impossible to 100% avoid doing all harm all the time, and because your choices are, for the most part, very responsible ones.  Importantly, that does something very profound to the food we eat (and the food we tube), I believe, or at least to how we assimilate it in ourselves.

How we feel about our food and tube food is just as important as the food itself, in my small and humble opinion.  If it's a burden, if there's a sense of stress, and it all comes down to being a chore - and if we doubt its goodness and whether it's the 'right' thing, then we are doing ourselves a great disservice.  Stress and worry are the biggest and most easily remedied influences on digestive health there are, and they're incredibly infectious.  A carer's stress will translate to a tubie's distress, without a word said or a mention made.  Just as if we're worrying about whether the processed comfort food we're eating is making us fatter and moving us ever closer to diabetes and a coronary before the age of 50 is more sure to make it so than being less worried, because the stress itself is bad for your heart and wreaks havoc with your digestion.  The worry itself creates that great, terrible feedback loop of nihilism - the one that returns you to the sofa with the soda, the chemically-enhanced 1500 cal popcorn with 1000% of your rdi of sodium, and the triple-choc fudge.

Better really is so much better than best in all this too.  Making a move in the crunchy direction not only makes further moves easier, but it makes 'retrograde' decisions less stressy too.  And you'll find over time you make fewer of those processed convenience-food type choices anyway, but enjoy them all the more because of it.

Nigella's hardly the role model for crunchy healthful planet-loving sustainable foodiness, but she's got one thing nailed for sure - genuine enjoyment is at least half the picture.

And since you're reading this here, chances are very high you already know the broad benefits of the Crunchy, and the major horrors of the slick, corporatized consumerist Smooth.  So your choice is fairly (or perhaps unfairly) clear - embrace a bit of a crunchwards direction in your food and tube life, or be prepared for the pressure and stress of your resistance to make you feel worse and more disconnected as time goes on.

I believe in the end that natural selection-type pressures will prevail over our dietary and lifestyle mistakes anyway.  We will all die too, of course; so in the light of this mortal reminder the only real question is this:

How smooth do we want our change into the crunchy future to be?