BD: Pros, Cons, and controversies

Blenderized diets (BD) were the original tube feed.  Old-school dietitians will remember making recipes for purees before the days of custom-made enteral formulae.  There were many reasons for the rise of fomula as the primary feedstuff for tubes, and I'm sure discussions on this will rear their heads, but in any case it's true that more and more lately we are witnessing a return to BD as a choice and option, all over the world.

There are a few main issues that come up whenever considering starting with BD or discussing it with a medical practitioner.  So, as I'm not here to sell anything but rather to explore and maybe help people discover stuff and feel empowered, let's deal with the common negatives first.

The (Alleged) Cons

BD is less hygienic, and carries a higher risk of infection.
No, not necessarily at all.  Unless of course you don't follow basic food safety practices.  It's just like cooking, only easier.  I have never managed to give myself or anyone I know food poisoning of any degree in twenty-something years of cooking, and I'm by no means a hygiene control freak.  I just use common sense.

There are some special precautions that apply to BD though.
If you're going to be using a pump, and the bag will be hanging for a long time (as in an overnight feed) you're going to want to do something about ambient temperature.  Mostly, not living in the tropics would do the trick, but do consider this carefully.  You don't leave perishable food out of the fridge overnight and expect it to be fine the next morning, right?  (Lucky we got away with that 'breakfast pizza' in University party days, hey?)  Some folks make contraptions to keep the bag cool to start with.
Tube equipment needs proper cleaning.  This applies to whatever you're putting through there of course, but some blends can adhere to the sides pretty well.  A good oil content helps, but just make sure you don't skimp on the cleanliness stuff, OK?
Formula can grow bacteria too.  In fact, it's a perfect growth medium.  Take care.

BD will clog the tube.
Yes, it can, no point denying it.  However, far more frequently the cloggy culprit is inadequately crushed meds (which will happen with formula users too of course).  Also on the plus side, tube blockages don't have to be a major drama.  I used to be petrified of clogging mine - it's a big psychological deal, and not to be underestimated - but I've done it a few times now, once rather stubbornly, but I have yet to hear of a complete blockage that required a hospital trip. So...
Be careful with your blends.  Some stuff is harder to blend totally smoothly than others (there will be many posts on this for sure) but a high-end blender (see the Blenders and Blending page) will do the job given half a chance.  If you're using an ordinary blender then it can be prudent to use a strainer too (depending on ingredients) but you'll lose fibre.  I personally blend as short a time as I can and have had a few "oh no" moments watching a larger-than-tube-diameter chunk of vegetable matter that somehow escaped the blades tip gracefully into my upturned syringe, thinking "this will be interesting" only to have nothing happen.  It's actually harder to block a tube than you think and easier to unblock than you might fear.  This is a bogus 'con'.

You can't make a BD as nutritonally dense or complete as a formula.
Yes, you can.  Moreso even, if you want.  It comes down to ingredients and feeding technique mainly.  If you're using a pump or gravity a blend will typically have to be a thinner consistency, which is more difficult to get calories packed in to.  On the other hand (and there are no peer-reviewed studies to back this up, it's observational only) a substantial majority of both children and adults can 'tolerate' in the order of twice the volume of BD compared to formula.  So, if you find this is the case, you can be more casual with calories.  I don't count any more, but a 400ml BD I do has about the same calories as a 250ml 1.5Cal can.  I could make it denser but I like it this way better, for lots of reasons.

It's a lot more work.
This is often code for a mistrustfulness of your commitment to doing a good job of caring (for yourself or another).  It is 'harder' to do the blending, cleaning, storing, and so on, but if your enjoyment outweighs that then it's not hard in the least.  I have spoken to a couple of dietitians that have told me they simply could not in good conscience recommend BD as an option to certain of their patients because they have no confidence that they could do it successfully.  It does require thought and care and a bit of effort.  Just like most of life.

Sure, there are probably more, but as this thing is a permanent work in progress watch this space.  Or suggest what should go here.

But now, for...

The Pros

It's food.  You can put in what you want.
Says it all really, there's nothing like food for fulfilling the body's needs.  We've evolved (or been designed - you choose, I don't mind) to be very much attuned with the sorts of stuff you find lying around nature for eating purposes, and in the last couple of millenia we've made a few adjustments to various plants and animals to our advantage.  Also some adjustments that are not so good.  Regardless of your opinions about modern farming and food processing practices and ethics, the super part of BD is that you are so much freer to choose your own ingredients.  Just as you are when you eat with a mouth.  Interestingly, I hear overwhelmingly that people on BD 'eat' better than they ever did, and better than other non-tube-fed folks in their peer group.  Overcompensation or just heightened consciousness?

Nutrition, nutrition, nutrition.
And nutrition.  However much science you pack into a can, however long the list of supposed nutrients is, it can never come close to replicating real food, with all its amazing compounds and micronutrients.  If it did - if it were actually as 'complete' as advertised - then the folks that make and prescribe such formulas would live off it, yes?  Enough said.

Nutrition Part 2.
High-end blenders like the VitaMix do amazing things you can take advantage of.  Their blades spin so fast that they smash up cell walls, releasing nutrients from raw foods that would otherwise have been unavailable or lost in cooking.  If you wish to retain these you need to ensure the blend does not get too hot, which brings me to the other feature - cooking.  The blades cook by friction.  If you leave your blend going for only a few minutes it will get hot and start to cook.  If you want this, how easy!  If not, it's easy enough to avoid.  See Blenders and Blending.  So, with BD you can actually get more from the food you use than you would if you just ate it.

Blending is so incredibly easy compared to cooking.  You'll see.

Sure, most of my blends are a bit sameish, but no two are really the same.  With BD you have the choice to introduce a variety of foods; in a way, replicating nature's seasonality and the more usual habits of mouth-eating people.  Not many people I know have the same meal every time.  The flip side - and this is a good thing too - is that with a tube you can have the same diet for days on end if that's what you need (like recovering from illness etc) and never get bored with eating it.

I get a tiny sensation of taste, probably mostly from smell, with my blends.  I can also tell you that reflux with formula is utterly hideous but reflux with BD is not so bad.  Again, a dounle-edged sword.  If you are helping wean a child, say, off tube feeding then having a good tasting blend for them to play with or eat orally will help a great deal.  On the other hand, if there is no real need for taste to be a factor (like with me) then you can combine ingredients you'd never put together in a meal - cooking without bad consequences.  Mm, seaweed and chocolate, yum!

Reconnection with caring.
A majority of tube-fed people are cared for by others, like a parent, spouse, child, or the like; often people who might regularly cook or prepare food for that person.  Opening cans of what really amounts to corn syrup and highly processed stuff can feel really un-nourishing.  Many parents and other carers report a really welcome sense of re-empowerment when incorporating BD, like they're able to do their 'natural' job of providing.  It can make mealtimes more natural-seeming.  And for those of us who do our own, this applies too.  You can go out to the garden and down to the store with a purpose again, rather than just opening a new, same-old carton.

Related to the last point, but with a special difference.  Most tube-fed folks have a reasonably medically complex thing going on, and even if not then the whole tube ownership and care rigmarole is necessarily quite medicalised in and of itself.  BD, being something you made at home (usually), with fresh and real ingredients (most likely) just makes such a difference in reclaiming some feeling of control of your own or your caree's health back from the medical establishment. 

All sorts of other wellbeing benefits reported.
the main thing being, of course, digestibility.  Natural food is what we were orginally designed/evolved  for so it's hardly surprising that most people who switch from formula to BD repot improvement or total cessation of issues like diarrhea and constipation - things most formulae are notorious for.  Likewise, reflux issues are often improved or dissappear.  Many carers report a renwed 'glow' a 'healthier-looking' skin return, and the cessation of things like nappy rash, skin complaints and irritability.  This list really is endless.

Naturally, I've just skimmed the surface here.  More will surely follow as you tip in your own experiences.  But as long as there is the scientific method, and as long as we as a society insist on using words like 'should', then there will always be the......


Weight loss/gain
Quite a large percentage of people report an initial weight loss (in relatively 'underweight' children especially) when transitioning from formula to BD.  This can be very concerning.  I should point out again that there is no scientific literature to expain any of this, only conjecture.  Almost everyone who has reported such weight loss has seen the trend reverse and weight gain take place at an increased pace.  The most common theory I have heard involves the concept of 'empty calories'. What this means is that the body has been artificially high in stored fats from the huge refined sugar quotient in formulae, and is now shedding this unhealthy excess and 'remembering' how to digest real food again.

Similarly, some people who are effectively overweight gain even more on BD.  the plus side of this though is that dietary restriction is easier and healthier to do through change in the composition of the blends.

Controversial?  Depends on your ethics and where you live.  If you're in a country with subsidised food production and a for-profit medical system, then BD is for sure going to be much cheaper.  On the other hand, if your medical system is subsidised (and formula is thus cheaper) but grocery prices for real food are higher then a blenderized diet may in fact prove more expensive.  Either way, much of it will come down to your choice of ingredients and their local availability.

Processed foods
There are those who see that the opportunity to use high-quality natural foods for BD (when you have a top quality blender) means that using processed foods 'should' be a no-no.  I don't see it like that.  Personally, I use a high percentage of fresh and raw stuff, but I don't see there is a place for competitive dogma when it comes down to wellbeing.  Whatever works for you is good.

There is no science.
There are precious few studies out there in scientific literature land on BD, and not many more on enteral formula usage.  This means that many medicos are simply loathe to consider BD as an alternative, despite the obvious fact that they eat food themselves.  What studies there are have almost invariably been funded and/or conducted by formula manufacturers.  As mentioned previously, there is a widespread resistance to BD in many areas of current medical practice, but this is changing.  The one thing that's changing it the fastest and most effectively is advocacy by you and me, and insistence on the basic human rights to fresh food, and to feed yourself and your child or loved one as best you see fit.